Cornée C, Orignac I, Wargny M, Clément M, Varnier C, Le Meur G, Lebranchu P, Weber M
Service d'ophtalmologie, centre hospitalo-universitaire de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
Service d'ophtalmologie, centre hospitalo-universitaire de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
J Fr Ophtalmol. 2022 Oct;45(8):872-882. doi: 10.1016/j.jfo.2022.04.007. Epub 2022 Jul 26.
XEN 45® gel stent is an ab interno aqueous humor drainage device indicated for moderate glaucoma refractory to medical management. Its efficacy has been demonstrated in primary open-angle glaucoma (POAG). However, there are few studies on secondary glaucoma, including steroid-induced glaucoma (CG), defined as optic neuropathy induced by using local or systemic corticosteroids without increased flare.
We conducted a dual-center comparative cohort study between April 2019 and January 2021. 66 operated eyes were included, divided into two groups: POAG (56 eyes) and GC (10 eyes). The primary endpoint was the relative reduction in intraocular pressure (IOP) at three months postoperatively in the GC group. Three outcomes were defined: total success, partial success and failure.
The total success rate was 100% in the GC group and 42.6% in the POAG group. Preoperative IOP was 36.1±9.1mmHg and 19.0±7.3mmHg respectively. IOP reduction was 69.1±11.7% in the GC group and 21.8±30.3% in the POAG group. Patients were younger in the GC group (49.3±21.2 versus 71.1±8.4 years), and preoperative conjunctival preparation was longer in this group (12 versus 5 weeks). The needling rate was 17.9% in the POAG group and 10% in the GC group.
The XEN 45® gel stent is effective in the treatment of steroid-induced glaucoma. Further studies will be required to identify predictive factors for success and to establish criteria for good candidacy.
XEN 45®凝胶支架是一种用于难治性中度青光眼的房水引流装置，通过眼内植入。其疗效已在原发性开角型青光眼（POAG）中得到证实。然而，对于继发性青光眼，包括类固醇性青光眼（CG）的研究较少，CG定义为使用局部或全身皮质类固醇而无flare增加所诱发的视神经病变。
我们在2019年4月至2021年1月期间进行了一项双中心比较队列研究。纳入66只手术眼，分为两组：POAG（56只眼）和GC（10只眼）。主要终点是GC组术后三个月眼压（IOP）的相对降低。定义了三个结果：完全成功、部分成功和失败。
GC组的总成功率为100%，POAG组为42.6%。术前IOP分别为36.1±9.1mmHg和19.0±7.3mmHg。GC组IOP降低69.1±11.7%，POAG组为21.8±30.3%。GC组患者较年轻（49.3±21.2岁对71.1±8.4岁），且该组术前结膜准备时间更长（12周对5周）。POAG组的针刺率为17.9%，GC组为10%。
XEN 45®凝胶支架治疗类固醇性青光眼有效。需要进一步研究以确定成功的预测因素并建立良好候选标准。
