Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai.
Department of Ophthalmology, Icahn School of Medicine at Mount Sinai.
J Glaucoma. 2021 Nov 1;30(11):988-995. doi: 10.1097/IJG.0000000000001929.
Sub-Tenon's implantation of the Xen Gel stent resulted in significant intraocular pressure (IOP) lowering along with a low rate of postoperative bleb needling, and a favorable bleb morphology on anterior segment optical coherence tomography (AS-OCT).
The aim was to assess clinical outcomes and bleb morphology following sub-Tenon's implantation of the Xen Gel Stent.
The medical records of patients who underwent sub-Tenon's Xen Gel Stent implantation with intraoperative mitomycin-C through an open conjunctival approach were reviewed. Postoperative IOP and number of glaucoma medications at 1, 3, 6, 9, and 12 months were assessed. Bleb morphology was analyzed at various timepoints using AS-OCT (Topcon DRI OCT version 1.1.1).
Twenty-six eyes were included in the study. Mean age was 69.4±8.0 years. Mean preoperative IOP was 28.1±7.8 mm Hg on an average of 3.5±0.9 glaucoma medications. Mean IOP at postoperative month 12 (n=23 eyes) was 12.9±4.0 mm Hg (P<0.01) on an average of 0.3±0.6 (P<0.01) glaucoma medications. Three eyes (12%) required postoperative needle revision. Bleb morphology in the early postoperative period (≤3 mo) was characterized by multiple small subconjunctival microcysts on AS-OCT. At the intermediate (6 to 12 mo) and long-term (>12 mo) timepoints, reduction in microcysts with multiple internal parallel layers of aqueous flow and a uniform pattern were more frequently noted. All functional blebs were characterized by the presence of a posterior episcleral fluid lake. Failed blebs showed absence of aqueous humor around the distal end of the microshunt.
Following an open conjunctival approach, sub-Tenon's placement of the Xen Gel Stent with significant IOP lowering was achieved. In eyes with good shunt function, bleb morphology by AS-OCT showed a posterior episcleral fluid lake similar to findings following trabeculectomy.
经巩膜睫状体Tenon 下植入 Xen Gel 支架可显著降低眼内压（IOP），术后行巩膜下注射的需求低，前节光学相干断层扫描（AS-OCT）显示出良好的滤过泡形态。
评估经巩膜睫状体 Tenon 下植入 Xen Gel 支架的临床结果和滤过泡形态。
回顾性分析了 26 例行经巩膜睫状体 Tenon 下植入 Xen Gel 支架联合术中丝裂霉素 C 开放结膜入路手术的患者的病历资料。评估术后 1、3、6、9 和 12 个月时的 IOP 和降眼压药物的数量。使用 AS-OCT（Topcon DRI OCT 版本 1.1.1）在不同时间点分析滤过泡形态。
研究纳入 26 只眼。平均年龄为 69.4±8.0 岁。平均术前 IOP 为 28.1±7.8mmHg，平均使用 3.5±0.9 种降眼压药物。术后 12 个月时（n=23 只眼）平均 IOP 为 12.9±4.0mmHg（P<0.01），平均使用 0.3±0.6 种降眼压药物（P<0.01）。3 只眼（12%）术后需要行巩膜下注射。AS-OCT 显示术后早期（≤3 个月）滤过泡表现为多个小的结膜下微囊。在中期（6 至 12 个月）和长期（>12 个月）时，更常观察到微囊减少，出现多个内部平行的房水流动层和均匀的形态。所有功能性滤过泡均表现为后巩膜液池。失败的滤过泡表现为微瘘管末端无房水。
经开放结膜入路，经巩膜睫状体 Tenon 下植入 Xen Gel 支架可显著降低 IOP。在具有良好分流功能的眼中，AS-OCT 显示的滤过泡形态类似于小梁切除术的后巩膜液池。
