Burggraaf-Sánchez de Las Matas Raquel, Such-Irusta Laura, Alfonso-Muñoz Enrique A, Mascarós-Mena Héctor, Lanzagorta-Aresti Aitor, Mataix-Boronat Jorge, Font-Julià Carolina
Department of Glaucoma-Ophthalmology, University Hospital of Castellón, Castellón, Spain.
Department of Ophthalmology, Hospital of Sagunto, Sagunto, Valencia, Spain.
J Curr Glaucoma Pract. 2021 Sep-Dec;15(3):153-160. doi: 10.5005/jp-journals-10078-1316.
To report the incidence of late-onset endophthalmitis following XEN45 stent implantation.
Long-term safety profile and efficacy in relation to the so-called microinvasive glaucoma surgery (MIGS) techniques are still under evaluation. The XEN45 gel stent entails a bleb formation and often requires postoperative conjunctival management, differing from the current reviewed concept of minimally invasive procedures. Endophthalmitis has been described among the complications, triggered in the majority of cases by tube extrusion.
From our chart of 293 eyes operated on between November 2016 and November 2019, five (1.7%) patients developed endophthalmitis, which took place in the months 3, 4, 5, 11, and 14 after surgery, respectively. Sixty percent had undergone previous needling procedures. All of them showed a previous flat bleb and developed perforation of the conjunctiva caused by the distal portion of the tube. One patient was early eviscerated due to a fateful course. Treatment consisted of intravitreal, oral, and topical antibiotics, as well as topical corticosteroids. Eighty percent underwent device withdrawal, conjunctival gap suturing, anterior chamber washout, aqueous humor (AH) tab extraction (one positive for and one for ), and pars plana vitrectomy. A second patient was eviscerated due to phthisis bulbi. Out of three remaining patients, one underwent vitrectomy for retinal detachment, while two patients required glaucoma surgery for intraocular pressure control. The final VA was ≤20/125 in all patients.
The XEN45 device appears to trigger endophthalmitis by extruding the stent or unnoticed leakage through conjunctival defects. Special attention should be paid to flat and avascular blebs.
This series shows a higher rate of endophthalmitis (1.7%) compared with previous studies with a significant sample size (0.4-1.4%).
Burggraaf-Sánchez de las Matas R, Such-Irusta L, Alfonso-Muñoz EA, Late-onset Endophthalmitis after XEN45 Implantation: A Retrospective Case Series and Literature Review. J Curr Glaucoma Pract 2021;15(3):153-160.
报告XEN45支架植入术后迟发性眼内炎的发生率。
与所谓的微创青光眼手术（MIGS）技术相关的长期安全性和疗效仍在评估中。XEN45凝胶支架会形成一个滤过泡，且术后常需要结膜处理，这与目前所认可的微创概念不同。眼内炎已被列为并发症之一，大多数情况下是由引流管脱出引发的。
在我们2016年11月至2019年11月期间手术的293只眼中，有5例（1.7%）患者发生了眼内炎，分别在术后3、4、5、11和14个月出现。60%的患者之前接受过针刺治疗。所有患者之前均有扁平滤过泡，且因引流管远端导致结膜穿孔。1例患者因病情严重早期进行了眼球摘除术。治疗包括玻璃体内、口服和局部应用抗生素，以及局部应用皮质类固醇。80%的患者进行了装置取出、结膜创口缝合、前房冲洗、房水穿刺抽液（1例培养出[具体细菌名称1]，1例培养出[具体细菌名称2]）和平坦部玻璃体切除术。另1例患者因眼球痨进行了眼球摘除术。在其余3例患者中，1例因视网膜脱离接受了玻璃体切除术，2例患者需要进行青光眼手术以控制眼压。所有患者最终的视力均≤20/125。
XEN45装置似乎通过引流管脱出或经结膜缺损处未被注意到的渗漏引发眼内炎。应特别关注扁平无血管滤过泡。
与之前样本量较大的研究（0.4 - 1.4%）相比，本系列研究显示眼内炎发生率更高（1.7%）。
Burggraaf-Sánchez de las Matas R, Such-Irusta L, Alfonso-Muñoz EA, XEN45植入术后迟发性眼内炎：一项回顾性病例系列研究及文献综述。《当代青光眼实践杂志》2021；15(3):153 - 160。
