用于遗传性转甲状腺素蛋白淀粉样变性（hATTR）继发性开角型青光眼的Ex-PRESS滤过装置联合巩膜瓣下植入改良技术
Modified Technique of Ex-PRESS Filtration Device Combined with a Scleral Pocket for Hereditary Transthyretin Amyloidosis (hATTR) Secondary Open-Angle Glaucoma.
作者信息
Vieira Rita, Marta Ana, Ferreira André, Figueiredo Ana, Reis Rita Falcão, Sampaio Isabel, Menéres Maria João
机构信息
Ophthalmology Department of Centro Hospitalar Universitário do Porto (CHUPorto), Oporto, Portugal.
Ophthalmology Teaching Department, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Oporto, Portugal.
出版信息
Clin Ophthalmol. 2023 Jan 31;17:403-411. doi: 10.2147/OPTH.S394360. eCollection 2023.
PURPOSE
To evaluate the effectiveness and safety of a modified approach using the Ex-PRESS implant combined with a scleral pocket in the management of secondary open-angle glaucoma in hereditary transthyretin amyloidosis (hATTR) at our department.
METHODS
This was a retrospective analysis. The primary endpoints included Intraocular pressure (IOP) evaluation (baseline, 1st day, 1st week, 1, 3, 6, 12 months and at last follow-up) and number of hypotensive drugs (baseline, 6th, 12th months and at last follow-up). As secondary endpoints surgical complications, the need for additional glaucoma surgery and LogMAR BCVA were evaluated. Qualified and complete success were defined as ≥ 30% IOP decrease from baseline, with or without additional medications, respectively. The minimum follow-up was 12 months.
RESULTS
A total of 32 eyes were included with a mean follow-up of 2.4±2.9 years. IOP decreased significantly from baseline (27.4±4.4 mmHg) to 1st day (5.00±2.9 mmHg), 1st week (6.9±4.1 mmHg), 1st month (11.7±7.8 mmHg), 3rd month (11.6±6.1 mmHg), 6th month (13.1±6.8 mmHg), 12th month (12.0±3.5 mmHg) and last visit (11.8±2.4 mmHg), p<0.001. There was also a significant reduction in the number of antiglaucoma medications from baseline (3.8±0.6) and last follow-up (0.4±0.8), p<0.001. LogMAR BCVA remained stable (0.25±0.26 at baseline and 0.25±0.24 at last follow-up), p=0.767. Transient hypotony occurred in 17 eyes (53.1%), but only 11 (34.4%) exhibited anterior chamber shallowing and needed additional care, namely cycloplegic drops and viscoelastic injection. Complete surgical success was achieved in 22 eyes (68.8%) and qualified success in 6 eyes (18.8%). Four eyes (12.5%) needed additional glaucoma surgery.
CONCLUSION
The modified ExPRESS technique appears to be effective, especially when low levels of IOP are required. Additionally, fewer anti-glaucoma drugs were necessary. In the other hand, hypotony was a common side effect with this procedure, although all patients were properly handled, preserving the surgical outcomes.
目的
评估在我院采用Ex-PRESS植入物联合巩膜囊袋改良方法治疗遗传性转甲状腺素蛋白淀粉样变性（hATTR）所致继发性开角型青光眼的有效性和安全性。
方法
这是一项回顾性分析。主要终点包括眼压评估（基线、第1天、第1周、1、3、6、12个月及最后随访）和降压药物数量（基线、第6、12个月及最后随访）。作为次要终点，评估手术并发症、额外青光眼手术的需求以及LogMAR最佳矫正视力（BCVA）。合格成功和完全成功分别定义为眼压较基线降低≥30%，无论有无额外用药。最短随访时间为12个月。
结果
共纳入32只眼，平均随访2.4±2.9年。眼压从基线（27.4±4.4 mmHg）显著降低至第1天（5.00±2.9 mmHg）、第1周（6.9±4.1 mmHg）、第1个月（11.7±7.8 mmHg）、第3个月（11.6±6.1 mmHg）、第6个月（13.1±6.8 mmHg）、第12个月（12.0±3.5 mmHg）和最后一次就诊时（11.8±2.4 mmHg），p<0.001。抗青光眼药物数量从基线（3.8±0.6）和最后随访时（0.4±0.8）也有显著减少，p<0.001。LogMAR BCVA保持稳定（基线时为0.25±0.26，最后随访时为0.25±0.24），p=0.767。17只眼（53.1%）发生短暂性低眼压，但只有11只眼（34.4%）出现前房变浅并需要额外处理，即使用睫状肌麻痹滴眼液和黏弹剂注射。22只眼（68.8%）实现了完全手术成功，6只眼（18.8%）实现了合格成功。4只眼（12.5%）需要额外的青光眼手术。
结论
改良的ExPRESS技术似乎有效，尤其是在需要低眼压水平时。此外，所需的抗青光眼药物较少。另一方面，低眼压是该手术常见的副作用，尽管所有患者都得到了妥善处理，手术效果得以保留。
Zotero 插件