Gallardo Mark J, Vincent Logan R, Porter Matthew
El Paso Eye Surgeons, El Paso, TX, USA.
Department of Ophthalmology, Texas Tech University School of Medicine, Lubbock, TX, USA.
Clin Ophthalmol. 2022 Jul 6;16:2187-2197. doi: 10.2147/OPTH.S354038. eCollection 2022.
To compare clinical outcomes following gel stent implantation via ab externo and ab interno approaches in patients with refractory glaucoma.
This retrospective study included 203 eyes of 185 patients aged ≥45 years who underwent Xen gel stent implantation as a standalone procedure for medically uncontrolled glaucoma (intraocular pressure (IOP) ≥18 mmHg) despite maximum tolerable IOP-lowering medications. One hundred and five eyes underwent gel stent implantation via ab interno approach and 98 via ab externo. Patients with prior conjunctival-incisional glaucoma or cataract surgery were also included. Study parameters were reduction in IOP and number of IOP-lowering medications from baseline to 3, 6, 9 and 12 months postoperatively.
There were no statistically significant differences in the age, sex, preoperative IOP, number of IOP-lowering medications or cup-disc ratio between the ab interno and ab externo groups at baseline (p > 0.05). At all postoperative time points, mean IOP and percentage reduction from baseline were comparable in both groups (p > 0.05) except at postoperative 6 months when the outcomes were significantly better (p < 0.05) in the ab externo group. The rate of postoperative procedures (5-Fluorouracil injections and bleb needling), the incidence of numerical or clinical hypotony and adverse events were comparable in both groups (p > 0.05). The mean number of IOP-lowering medications was comparable in both groups at all time points.
The Xen gel stent, whether implanted ab interno or ab externo, is effective in reducing IOP and dependence on topical medications in eyes with refractory glaucoma. The stent may be used in both phakic and pseudophakic patients and is a reasonable option for patients with prior failed trabeculectomy.
比较难治性青光眼患者经外路和经内路植入凝胶支架后的临床疗效。
本回顾性研究纳入了185例年龄≥45岁的患者的203只眼睛，这些患者尽管使用了最大耐受剂量的降眼压药物，但眼压仍未得到控制（眼压≥18 mmHg），并接受了Xen凝胶支架植入作为独立手术治疗青光眼。105只眼睛经内路植入凝胶支架，98只眼睛经外路植入。既往有结膜切开性青光眼或白内障手术史的患者也被纳入。研究参数包括从基线到术后3、6、9和12个月眼压的降低情况以及降眼压药物的数量。
基线时，经内路和经外路组在年龄、性别、术前眼压、降眼压药物数量或杯盘比方面无统计学显著差异（p>0.05）。在所有术后时间点，两组的平均眼压和相对于基线的降低百分比相当（p>0.05），但术后6个月时，经外路组的结果明显更好（p<0.05）。两组的术后操作率（5-氟尿嘧啶注射和滤泡针刺）、数值性或临床性低眼压发生率及不良事件发生率相当（p>0.05）。在所有时间点，两组降眼压药物的平均数量相当。
Xen凝胶支架无论是经内路还是经外路植入，在降低难治性青光眼患者的眼压和减少局部药物依赖方面均有效。该支架可用于有晶状体眼和人工晶状体眼患者，对于既往小梁切除术失败的患者也是一个合理的选择。
