Hasan Somar M, Theilig Theresa, Tarhan Melih, Papadimitriou Menelaos, Unterlauft Jan Darius, Meller Daniel
Department of Ophthalmology, Jena University Hospital, Jena, Germany.
Department of Ophthalmology, Bern University Hospital, Bern, Switzerland.
J Glaucoma. 2023 Feb 1;32(2):117-126. doi: 10.1097/IJG.0000000000002096. Epub 2022 Aug 9.
A novel qualitative tomographical classification for bleb after implantation of XEN-Gel-Stent using ab interno approach is presented. Association of anatomic patterns to intraocular pressure (IOP) and success rates (SR) illustrates that anterior segment optical coherence tomography can be useful tool in clinical guidance.
To present a novel classification of bleb resulting from ab interno implantation of XEN-Gel-Stent and report association of tomographical patterns with IOP and SR.
A cross-sectional 1-armed study of patients receiving XEN-Gel-Stent. Tomographical changes in the bleb area were studied using swept-source optical coherence tomography in an early (d 29-90 postsurgery) and late (starting from d 91 postsurgery) phase. Frequency of patterns and their association with IOP and SR (defined as IOP<18 mmHg without medications) were studied.
One hundred eleven examinations of 49 blebs (49 patients) were included. Three tomographical patterns at conjunctival, 4 at tenons capsule, and 2 at episcleral level were characterized. Most frequent conjunctival pattern was subconjunctival spaces (56.3% and 53.2% in the early and late phase, respectively) and associated with lower IOP (13.0±6.0 mmHg) and higher SR (89%) but only in the early phase compared with other conjunctival patterns ( P <0.05). At tenons capsule level, the hyporeflective pattern was most frequent (50% and 51.9% in early and late phase) followed by the cavernous pattern. Both patterns associated with lower IOP and higher SR compared with hyper-reflective or loss of tenon changes ( P <0.005). Most blebs showed no episcleral lake (87.5% and 89.9% in early and late phase). No difference of IOP and SR was noted compared with those showing an episcleral lake.
A practical and clinically relevant novel classification system is proposed to tomographically describe and classify blebs after implantation of XEN-Gel-Stent. Certain patterns were associated with lower IOP and higher SR.
提出了一种使用内路法植入XEN凝胶支架后对滤泡进行定性断层扫描分类的新方法。解剖模式与眼压（IOP）和成功率（SR）的关联表明，眼前段光学相干断层扫描可成为临床指导中的有用工具。
提出一种因XEN凝胶支架内路植入导致的滤泡新分类方法，并报告断层扫描模式与IOP和SR的关联。
对接受XEN凝胶支架的患者进行一项横断面单臂研究。使用扫频光学相干断层扫描在早期（术后29 - 90天）和晚期（术后91天起）研究滤泡区域的断层扫描变化。研究模式的频率及其与IOP和SR（定义为无需药物治疗时IOP < 18 mmHg）的关联。
纳入了对49个滤泡（49例患者）的111次检查。在结膜、Tenon囊和巩膜上分别确定了3种、4种和2种断层扫描模式。最常见的结膜模式是结膜下间隙（早期和晚期分别为56.3%和53.2%），与较低的IOP（13.0±6.0 mmHg）和较高的SR（89%）相关，但仅在早期与其他结膜模式相比有差异（P < 0.05）。在Tenon囊水平，低反射模式最常见（早期和晚期分别为50%和51.9%），其次是海绵状模式。与高反射或Tenon改变缺失相比，这两种模式均与较低的IOP和较高的SR相关（P < 0.005）。大多数滤泡无巩膜湖（早期和晚期分别为87.5%和89.9%）。与有巩膜湖的滤泡相比，未观察到IOP和SR的差异。
提出了一种实用且与临床相关的新分类系统，用于对XEN凝胶支架植入后的滤泡进行断层扫描描述和分类。某些模式与较低的IOP和较高的SR相关。
