Indiana University School of Medicine, Indianapolis, IN.
Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO.
J Glaucoma. 2021 Jun 1;30(6):481-488. doi: 10.1097/IJG.0000000000001823.
Although the XEN stent offers a lower risk of hypotony and choroidal effusions with fewer clinic visits postoperatively, its surgical success rate was inferior to the EX-PRESS shunt.
To compare the clinical efficacy and safety outcomes of the XEN stent and EX-PRESS glaucoma drainage device in glaucomatous eyes.
One hundred eyes from 88 patients underwent ab interno XEN stent or EX-PRESS shunt implantation (52 XEN and 48 EX-PRESS) for uncontrolled glaucoma at the University of Colorado Eye Center. The primary outcome was surgical success defined as intraocular pressure (IOP) ≥6 and ≤18 mm Hg, without reoperation for uncontrolled glaucoma, loss of light perception, or use of glaucoma medications (complete success). Secondary outcomes were the same requirements allowing for medications (qualified success), mean IOP, medication use, adverse events, and number of postoperative clinic visits in the first 3 months.
Baseline characteristics including glaucoma type and severity were similar between groups, with the exception of XEN patients having fewer men (17% vs. 46%), older patients (median age, 78 vs. 68), and a higher percentage of white patients (89% vs. 69%). Adjusted hazard ratio of failure of XEN relative to EX-PRESS was 3.94 (95% confidence interval, 1.73-9.00, P=0.001) for complete success and 1.61 (95% confidence interval, 0.40-6.38, P=0.501) for qualified success. There were significantly fewer postoperative clinic visits during the first 3 months in the XEN group (5.3 vs. 9.1 visits, P<0.001). The incidence of serous choroidal effusions and hypotony was significantly less after XEN compared with EX-PRESS (1 vs. 9, P=0.02 and 15 vs. 25, P=0.023, respectively). Three XEN stents (5.8%) required removal.
In this population, although the XEN stent offers a better safety profile and fewer postoperative clinic visits, complete surgical success was inferior to the EX-PRESS shunt.
尽管 XEN 支架术后发生低眼压和脉络膜脱离的风险较低，且术后就诊次数较少，但手术成功率低于 EX-PRESS 分流器。
比较 XEN 支架和 EX-PRESS 青光眼引流装置在青光眼眼中的临床疗效和安全性。
在科罗拉多大学眼科中心，88 例患者（100 只眼）因未控制的青光眼行内眼 XEN 支架或 EX-PRESS 分流器植入术（52 只眼 XEN 和 48 只眼 EX-PRESS）。主要结局为手术成功定义为眼压（IOP）≥6mmHg 且≤18mmHg，无需再次手术治疗未控制的青光眼、无光感丧失或使用青光眼药物（完全成功）。次要结局为允许使用药物的相同要求（合格成功）、平均 IOP、药物使用、不良事件和术后前 3 个月的就诊次数。
两组的基线特征（包括青光眼类型和严重程度）相似，除 XEN 患者男性较少（17%对 46%）、年龄较大（中位数，78 岁对 68 岁）和白人患者比例较高（89%对 69%）外。XEN 相对于 EX-PRESS 完全成功的调整后风险比为 3.94（95%置信区间，1.73-9.00，P=0.001），合格成功的风险比为 1.61（95%置信区间，0.40-6.38，P=0.501）。XEN 组在前 3 个月的就诊次数明显减少（5.3 次对 9.1 次，P<0.001）。与 EX-PRESS 相比，XEN 后发生浆液性脉络膜脱离和低眼压的发生率明显较低（1 对 9，P=0.02 和 15 对 25，P=0.023）。3 只 XEN 支架（5.8%）需要取出。
在该人群中，尽管 XEN 支架的安全性更好，且术后就诊次数更少，但完全手术成功率低于 EX-PRESS 分流器。
