XEN明胶支架与丝裂霉素C小梁切除术的比较：一项回顾性研究
Comparison of XEN Gelatin Stent vs Trabeculectomy with Mitomycin C: A Retrospective Study.
作者信息
Sharpe Robert, Pham Gina, Chang Peter
机构信息
Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.
出版信息
J Curr Glaucoma Pract. 2020 Sep-Dec;14(3):87-92. doi: 10.5005/jp-journals-10078-1287.
AIM
To compare outcomes of XEN gelatin stent (Allergan, Dublin, Ireland) implantation vs trabeculectomy with mitomycin C (MMC).
MATERIALS AND METHODS
A retrospective review was conducted of eyes that underwent standalone XEN implantation or trabeculectomy with MMC at a single institution from 2014 to 2019. Intraocular pressure (IOP), visual acuity, glaucoma medications, complications, and postoperative interventions were evaluated. The primary endpoint was the reduction in IOP at 6 months postoperatively. Secondary endpoints included the incidence of postoperative intervention and complications.
RESULTS
One hundred and seventy-nine eyes were included who underwent XEN ( = 90) or trabeculectomy ( = 89). The mean age was 74.5 ± 7.6 and 68.1 ± 8.2 years old for the XEN and trab groups, respectively ( < 0.001). Baseline IOP for XEN was 17.8 ± 6.0 vs 20.4 ± 9.0 mm Hg for the trab group ( = 0.03). At 6 months, mean IOP for XEN group was 13.5 ± 5.9 mm Hg, representing a 24.1% IOP reduction from baseline ( < 0.001) while mean for trab group was 10.8 ± 4.8 representing a 47% IOP reduction from baseline ( < 0.001). The mean IOP was 2.7 mm Hg lower in trab compared to the XEN group at 6 months ( < 0.003). The number of medications was reduced in both groups from 2.9 ± 1.1 and 3.1 ± 0.9 to 1.1 ± 2.3 and 0.8 ± 1.4 by 6 months postoperatively for XEN and trab groups, respectively ( < 0.001). Complication rates were low for both groups. The needling rate was 30% in XEN vs 7.9% in the trab group ( < 0.001), and 46.1% of eyes in the trab group underwent laser suture lysis. Additionally, IOP reduction and complication rates were similar following XEN in eyes receiving <40 or ≥40 μg of MMC.
CONCLUSION
XEN implantation produces a substantial reduction in IOP with a favorable safety profile comparable to trabeculectomy. Careful postoperative bleb management is critical to obtain optimum outcomes, and higher MMC doses appear safe and may reduce needling rates.
CLINICAL SIGNIFICANCE
This study confirms the safety and efficacy of XEN gelatin stent implantation in comparison to trabeculectomy with MMC.
HOW TO CITE THIS ARTICLE
Sharpe R, Pham G, Chang P. Comparison of XEN Gelatin Stent vs Trabeculectomy with Mitomycin C: A Retrospective Study. J Curr Glaucoma Pract 2020;14(3):87-92.
目的
比较XEN明胶支架（爱尔康公司，都柏林，爱尔兰）植入术与丝裂霉素C（MMC）小梁切除术的疗效。
材料与方法
对2014年至2019年在单一机构接受单独XEN植入术或MMC小梁切除术的患者进行回顾性研究。评估眼压（IOP）、视力、青光眼用药情况、并发症及术后干预措施。主要终点是术后6个月眼压的降低情况。次要终点包括术后干预和并发症的发生率。
结果
共纳入179只眼，其中90只眼接受XEN植入术，89只眼接受小梁切除术。XEN组和小梁切除术组的平均年龄分别为74.5±7.6岁和68.1±8.2岁（P<0.001）。XEN组的基线眼压为17.8±6.0mmHg，小梁切除术组为20.4±9.0mmHg（P=0.03）。6个月时，XEN组的平均眼压为13.5±5.9mmHg，较基线降低24.1%（P<0.001），小梁切除术组的平均眼压为10.8±4.8mmHg，较基线降低47%（P<0.001）。6个月时，小梁切除术组的平均眼压比XEN组低2.7mmHg（P<0.003）。术后6个月，XEN组和小梁切除术组的用药数量分别从2.9±1.1和3.1±0.9减少至1.1±2.3和0.8±1.4（P<0.001）。两组的并发症发生率均较低。XEN组的针刺率为30%，小梁切除术组为7.9%（P<0.001），小梁切除术组46.1%的患者接受了激光缝线松解术。此外，接受<40或≥40μgMMC的患者在XEN植入术后的眼压降低情况和并发症发生率相似。
结论
XEN植入术可显著降低眼压，安全性良好，与小梁切除术相当。术后仔细管理滤泡对于获得最佳疗效至关重要，较高剂量的MMC似乎安全，且可能降低针刺率。
临床意义
本研究证实了XEN明胶支架植入术与MMC小梁切除术相比的安全性和有效性。
如何引用本文
Sharpe R, Pham G, Chang P. Comparison of XEN Gelatin Stent vs Trabeculectomy with Mitomycin C: A Retrospective Study. J Curr Glaucoma Pract 2020;14(3):87-92.
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