Theilig Theresa, Papadimitriou Menelaos, Albaba Ghaith, Meller Daniel, Hasan Somar M
Klinik für Augenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
Graefes Arch Clin Exp Ophthalmol. 2023 Nov;261(11):3249-3255. doi: 10.1007/s00417-023-06152-8. Epub 2023 Jul 6.
The success of filtering surgery as in XEN-Gel-Stent (XEN) and Preserflo-Microshunt (PF) depends mainly on a functioning bleb. Primary bleb failure (PBF) is not uncommon and can be treated with needling or open bleb revision (OBR). The aim of the study is to compare surgical outcomes of OBR after XEN and PF.
Eyes which received OBR as management of PBF following implantation of XEN or PF were retrospectively included. Intraocular pressure (IOP), number of IOP lowering medications (NoM), and success rates (SR) were compared between groups. Complete and qualified success were defined as IOP ≤18mmHg and a reduction of >20%, without and with medications, respectively.
29 eyes after XEN and 23 eyes after PF were included. Six months following OBR, IOP reduced from 24.2±4.7 to 13.5±4.6 after XEN and from 27.3±8.7 to 15.9±5.8mmHg after PF (both p<0.001). NoM did not change (0.7±1.3 to 0.4±0.8 after XEN and 1.2±1.3 to 1.0±1.5 after PF, p>0.05 for both). Complete SR were higher after XEN than after PF (58.6% vs. 30.4%, p=0.04). Complications were mild and managed mainly conservatively. Additional glaucoma surgery was needed in 17% and 30% of eyes after XEN and PF, respectively (p=0.26).
Although OBR was effective as management of PBF following XEN and PF, SR were higher after XEN than after PF along with comparable safety profile. The change of the surgical approach from ab interno during XEN-Implantation to ab externo during OBR seems to enhance SR compared to PF, where both interventions are done ab externo.
XEN凝胶支架（XEN）和Preserflo微分流器（PF）等滤过性手术的成功主要取决于功能性滤过泡。原发性滤过泡失败（PBF）并不罕见，可通过针刺或开放性滤过泡修复术（OBR）进行治疗。本研究的目的是比较XEN和PF植入术后OBR的手术效果。
回顾性纳入接受OBR治疗PBF的XEN或PF植入术后的眼。比较两组间的眼压（IOP）、降低IOP的药物数量（NoM）和成功率（SR）。完全成功和合格成功分别定义为IOP≤18mmHg且分别在不用药和用药情况下降低>20%。
纳入XEN术后29只眼和PF术后23只眼。OBR后6个月，XEN术后IOP从24.2±4.7降至13.5±4.6，PF术后从27.3±8.7降至15.9±5.8mmHg（均p<0.001）。NoM未改变（XEN术后从0.7±1.3降至0.4±0.8，PF术后从1.2±1.3降至1.0±1.5，两者p>0.05）。XEN术后的完全成功率高于PF术后（58.6%对30.4%，p=0.04）。并发症较轻，主要采用保守治疗。XEN和PF术后分别有17%和30%的眼需要额外的青光眼手术（p=0.26）。
尽管OBR作为治疗XEN和PF术后PBF有效，但XEN术后的成功率高于PF术后，且安全性相当。与PF相比，手术方式从XEN植入时的经内路变为OBR时的经外路似乎提高了成功率，PF的两种干预均为经外路。
