Konopińska Joanna, Saeed Emil, Lisowski Łukasz, Gołaszewska Kinga, Kraśnicki Paweł, Dmuchowska Diana Anna, Obuchowska Iwona
Department of Ophthalmology, Medical University of Bialystok, Kilinskiego 1 STR, 15-089 Bialystok, Poland.
J Clin Med. 2021 Sep 26;10(19):4410. doi: 10.3390/jcm10194410.
Glaucoma is the leading cause of irreversible blindness worldwide. The only proven factor in slowing the progression of glaucomatous neuropathy is lower intraocular pressure (IOP), which can be achieved with pharmacology, laser therapy, or surgery. However, these treatments are associated with various adverse effects, including corneal endothelial cell loss (CECL). In recent years, several novel surgeries for reducing the IOP, collectively referred to as minimally invasive glaucoma surgery (MIGS), have been developed, one of which is the iStent. However, the long-term effects of such surgeries remain unknown. We compared a group of patients with open-angle glaucoma and cataract who underwent phacoemulsification alone with a group of patients with similar demographic and clinical characteristics who underwent simultaneous phacoemulsification and iStent implantation. Overall, 26 eyes of 22 subjects who underwent a combined phacoemulsification-iStent procedure and 26 eyes of 24 subjects who underwent cataract surgery were included. Before surgery, endothelial cells accounted to 2228.65 ± 474.99 in iStent group and 2253.96 ± 404.76 in the control group ( = 0.836). After surgery, their number declined to 1389.77 ± 433.26 and 1475.31 ± 556.45, respectively ( = 0.509). There was no statistically significant difference in CECL between the two groups 18-24 months after surgery, despite increased manipulation in the anterior chamber and the presence of an implant in the trabecular meshwork in those with an iStent implant. Thus, iStent bypass implantation is a safe treatment in terms of CECL for mild-to-moderate open-angle glaucoma.
青光眼是全球不可逆性失明的主要原因。唯一被证实可减缓青光眼性神经病变进展的因素是降低眼压（IOP），这可通过药物治疗、激光治疗或手术实现。然而，这些治疗会带来各种不良反应，包括角膜内皮细胞损失（CECL）。近年来，已开发出几种降低眼压的新型手术，统称为微创青光眼手术（MIGS），其中之一就是iStent。然而，此类手术的长期效果仍不明确。我们将一组仅接受白内障超声乳化术的开角型青光眼和白内障患者与一组具有相似人口统计学和临床特征、同时接受白内障超声乳化术和iStent植入术的患者进行了比较。总体而言，纳入了22名接受白内障超声乳化术 - iStent联合手术患者的26只眼以及24名接受白内障手术患者的26只眼。手术前，iStent组的内皮细胞数量为2228.65±474.99，对照组为2253.96±404.76（P = 0.836）。手术后，它们的数量分别降至1389.77±433.26和1475.31±556.45（P = 0.509）。尽管iStent植入患者前房操作增加且小梁网中有植入物，但术后18 - 24个月两组间CECL无统计学显著差异。因此，就CECL而言，iStent旁路植入术对于轻度至中度开角型青光眼是一种安全的治疗方法。
