Complex Ophthalmology Structure, City of Health and Science of Turin, Department of Surgical Sciences - University of Turin, Turin.
Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan.
J Glaucoma. 2023 Mar 1;32(3):178-185. doi: 10.1097/IJG.0000000000002151. Epub 2022 Nov 25.
XEN45 implant was an effective and safe procedure in primary open angle glaucoma (OAG) eyes with high myopia. Although the hypotony incidence rate was relatively high, it resolved with medical therapy and was of short duration.
The purpose of this study is to evaluate the effectiveness and safety of the XEN45 stent in eyes with OAG and high myopia.
Retrospective and multicenter study.
Consecutive OAG patients who underwent a XEN45, either alone or in combination with cataract surgery, and had a refractive error higher than -6 D and an axial length ≥26 mm. The primary endpoint was the mean intraocular pressure (IOP) lowering at the last follow-up visit.
Thirty-one eyes were included (96.8% with a primary OAG diagnosis). The mean refraction was -13.2±5.6 (range: -6.75 to-23.0) D. In the overall study sample, preoperative mean IOP (95% CI) was significantly lowered from 23.5 (20.5-26.4) mm Hg to 13.0 (12.2-13.8) mm Hg at the last follow-up visit, P <0.0001. At the last follow-up visit, 16 (57.1%) eyes achieved an IOP ≤14 mm Hg, 11 (68.9%) of them without treatment. The number of ocular hypotensive medications was significantly reduced from 3.0±1.1 drugs at preoperatively to 0.6±1.0 drugs at the last follow-up visit, P <0.0001. Median (95% CI) follow-up was 24.0 (12.0-24.0) months. Linear regression analysis showed a significant correlation between the preoperative refraction and the IOP lowering ( r =0.43, P =0.0155). Needling procedure was performed in 11 eyes (39.3%) and hypotony (defined as an IOP <6 mm Hg) was observed in 8 eyes (28.6%) during the first postoperative day and remained for a week.
Although the Xen implant effectively lowered IOP in highly myopic eyes with glaucoma, the incidence of hypotony was high, and in most cases, resolved within the first month with medical management and monitoring.
XEN45 植入物在高度近视的原发性开角型青光眼（OAG）眼中是一种有效且安全的手术。虽然眼压降低的发生率相对较高，但通过药物治疗可以解决，且持续时间短。
本研究旨在评估 XEN45 支架在 OAG 和高度近视眼中的有效性和安全性。
回顾性多中心研究。
连续接受 XEN45 治疗的 OAG 患者，这些患者单独或联合白内障手术，屈光度高于-6D，眼轴长度≥26mm。主要终点是最后一次随访时的平均眼压（IOP）降低。
31 只眼（96.8%为原发性 OAG 诊断）纳入研究。平均屈光度为-13.2±5.6（范围：-6.75 至-23.0）D。在整个研究样本中，术前平均眼压（95%CI）从 23.5（20.5-26.4）mmHg 显著降低至最后一次随访时的 13.0（12.2-13.8）mmHg，P<0.0001。最后一次随访时，16 只眼（57.1%）眼压≤14mmHg，其中 11 只眼（68.9%）无需治疗。降眼压药物的数量从术前的 3.0±1.1 种显著减少至最后一次随访时的 0.6±1.0 种，P<0.0001。中位数（95%CI）随访时间为 24.0（12.0-24.0）个月。线性回归分析显示，术前屈光度与眼压降低呈显著相关性（r=0.43，P=0.0155）。在术后第 1 天，11 只眼（39.3%）行针刺术，8 只眼（28.6%）出现眼压过低（定义为眼压<6mmHg），持续 1 周。
尽管 Xen 植入物可有效降低青光眼高度近视眼的眼压，但眼压过低的发生率较高，且在大多数情况下，通过药物治疗和监测可在术后 1 个月内得到解决。
