Lions Eye Institute, Perth, Western Australia, Australia.
Ophthalmology department, Royal Perth Hospital, Perth, Western Australia, Australia.
Clin Exp Ophthalmol. 2023 Jan;51(1):19-30. doi: 10.1111/ceo.14181. Epub 2022 Nov 6.
The main objectives of this study were to determine whether known risk factors for trabeculectomy failure similarly influence gelatin stent outcomes and to identify surgical factors which may optimise success.
A retrospective, observational study was conducted at a single centre in Perth, Western Australia over 24 months. Two-hundred and sixty-two eyes of 207 patients underwent XEN-45 stent surgery with various forms of glaucoma. Surgical and postoperative data on subjects undergoing XEN-45 stent surgery was collated. Intraocular pressure (IOP) reduction success was determined using three criteria: 1; IOP <18 mm Hg, 2: IOP <15 mm Hg and 3: >25% IOP reduction from baseline. Kaplan-Meier, mixed effects Cox Proportional hazard model and Chi-Square test were used to measure survival of functioning stents.
The success rates at a maximum of 2 years after surgery by criteria 1, 2 and 3 were 61.3%, 26.2% and 28.9% in primary open angle glaucoma (n = 243), 18.8%, 16.9%, 21.4% in angle closure glaucoma (n = 11), 0%, 0%, 66.7% in congenital glaucoma (n = 5) and 0% in uveitic glaucoma (n = 3). No significant reduction in success was found in those eyes that had prior ocular surgery (all p > 0.07).
Prior cataract or trabeculectomy surgery does not appear to adversely affect gelatin stent outcomes over 2 years follow up. Gelatin stent surgery appears to have less IOP reduction effect compared to trabeculectomy at 2 years.
本研究的主要目的是确定已知的小梁切除术失败的危险因素是否同样影响明胶支架的结果，并确定可能优化手术成功率的手术因素。
在西澳大利亚珀斯的一个单一中心进行了一项回顾性、观察性研究，时间跨度为 24 个月。207 名患者的 262 只眼接受了 XEN-45 支架手术，这些患者患有各种类型的青光眼。收集了接受 XEN-45 支架手术的患者的手术和术后数据。采用三种标准来确定眼压（IOP）降低的成功率：1. IOP<18mm Hg；2. IOP<15mm Hg；3. 与基线相比，IOP 降低>25%。采用 Kaplan-Meier、混合效应 Cox 比例风险模型和卡方检验来测量功能支架的存活情况。
在手术后最长 2 年时，根据标准 1、2 和 3，原发性开角型青光眼（n=243）的成功率分别为 61.3%、26.2%和 28.9%，闭角型青光眼（n=11）的成功率分别为 18.8%、16.9%和 21.4%，先天性青光眼（n=5）的成功率分别为 0%、0%和 66.7%，葡萄膜炎性青光眼（n=3）的成功率为 0%。在那些之前有眼部手术的眼睛中，没有发现成功率显著降低（所有 p>0.07）。
在 2 年的随访中，白内障或小梁切除术的既往史似乎不会对明胶支架的结果产生不利影响。与小梁切除术相比，明胶支架手术在 2 年内的眼压降低效果较小。
