Département d'ophtalmologie, Université de Montréal.
Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
J Glaucoma. 2022 Aug 1;31(8):675-681. doi: 10.1097/IJG.0000000000002070. Epub 2022 Jun 30.
This pilot study of ab externo implantation of a gel microstent is a novel, minimally invasive glaucoma surgery performed at the slit lamp that is effective for lowering intraocular pressure in patients with uncontrolled glaucoma.
To evaluate the intraocular pressure (IOP)-lowering effect of gel microstent (XEN Gel Stent, Allergan, Irvine, CA) implantation using an ab externo approach in an office setting.
This retrospective, multicenter chart review examined outcomes in patients with uncontrolled glaucoma receiving maximally tolerated medical therapy, who underwent slit lamp ab externo gel stent implantation. At postoperative visit, the IOP, the number of glaucoma medications, the final position of the stent, and the needling rate were analyzed. Assessments were conducted 1 day, 1 week and 1, 3, 6, and 12 months after the implantation. Treatment success was defined as IOP ≥6 mm Hg and ≤18 mm Hg with ≥20% reduction from presurgical IOP, with or without medications.
Thirty-four eyes from 28 patients were included. Mean preoperative IOP was 24.1±8.0 mm Hg on 3.2±0.9 glaucoma medications. At 12 months postoperative, IOP was reduced to 15.4±4.7 mm Hg on 0.6±1.0 medications; 46.9% and 81.3% of eyes achieved complete and partial success, respectively. The gel stent was properly positioned in 94.1% of eyes after 1 attempt at implantation and in 100% of eyes after a second attempt. In addition to malpositioning, observed complications included occlusion, erosion, and endophthalmitis following anterior chamber reformation. Adjunctive needling was required in 21% of implanted eyes.
Slit-lamp-based transconjunctival XEN45 implantation reduced intraocular pressure in glaucoma patients in the first year of this pilot study and was most commonly associated with wound leak and hypotony among other adverse events.
这项关于外部植入凝胶微管的初步研究是一种新颖的、微创的青光眼手术，在裂隙灯下进行，对于降低未经控制的青光眼患者的眼内压是有效的。
评估在办公室环境下通过外部入路植入凝胶微管（XEN Gel Stent，Allergan，Irvine，CA）对眼内压（IOP）降低的效果。
这项回顾性、多中心图表回顾研究检查了接受最大耐受药物治疗的未经控制的青光眼患者接受裂隙灯外部凝胶支架植入术后的结果。在术后访问时，分析眼压、青光眼药物的数量、支架的最终位置和针刺率。评估在植入后 1 天、1 周、1、3、6 和 12 个月进行。治疗成功定义为眼压≥6mmHg 且≤18mmHg，与术前眼压相比降低≥20%，无论是否使用药物。
28 例患者的 34 只眼被纳入。术前平均眼压为 24.1±8.0mmHg，使用 3.2±0.9 种青光眼药物。术后 12 个月，眼压降至 15.4±4.7mmHg，使用 0.6±1.0 种药物；46.9%和 81.3%的眼分别达到完全和部分成功。凝胶支架在第一次植入尝试后 94.1%的眼中和第二次尝试后 100%的眼中位置正确。除了位置不当外，观察到的并发症包括前房重建后阻塞、侵蚀和眼内炎。在 21%的植入眼中需要辅助针刺。
在这项初步研究的第一年，基于裂隙灯的经结膜 XEN45 植入降低了青光眼患者的眼内压，最常见的并发症是伤口渗漏和低眼压，以及其他不良事件。
