Hasan Somar M, Theilig Theresa, Papadimitriou Menelaos, Meller Daniel
Department of Ophthalmology, Jena University Hospital, 07747 Jena, Germany.
Diagnostics (Basel). 2023 Jul 9;13(14):2318. doi: 10.3390/diagnostics13142318.
Evaluation of bleb morphology is a vital part of successful filtration glaucoma surgery. The PRESERFLO-MicroShunt (PRESERFLO) and XEN-Gel-Stent (XEN) are drainage devices implanted using different surgical approaches (ab externo and ab interno, respectively), potentially resulting in distinct bleb morphology. Understanding these morphological differences is essential for postoperative care. In this study, we retrospectively examined functioning blebs following PRESERFLO and XEN implantation using high-resolution anterior segment OCT imaging. Qualitative assessment utilizing the Jenaer Bleb Grading System and quantitative assessment measuring 12 parameters representing bleb dimensions were conducted, and the results were compared between the two groups. A total of 80 eyes from 80 patients were included (41 after PRESERFLO, 39 after XEN). Functioning blebs following PRESERFLO exhibited a higher frequency of hyperreflective tenon changes compared to XEN (31.7% vs. 10.3%, respectively, = 0.02) and a lower frequency of cavernous changes (17.1% vs. 35.9%, = 0.05). Additionally, PRESERFLO blebs showed a higher frequency of visible episcleral lakes (92.7% vs. 30.8%, < 0.001). Furthermore, PRESERFLO blebs demonstrated larger height (2.13 ± 0.5 vs. 1.85 ± 0.6 mm, = 0.03), width (10.31 ± 2.3 vs. 9.1 ± 2.3 mm, = 0.02), length (9.13 ± 1.8 vs. 8.24 ± 1.9 mm, = 0.04), posterior location relative to the limbus (6.21 ± 1.2 vs. 5.21 ± 1.8 mm, = 0.005), and a thicker bleb wall (1.60 ± 0.5 vs. 1.1 ± 0.4 mm, = 0.004). Functioning blebs following PRESERFLO and XEN displayed morphological distinctions, likely attributed to variations in surgical techniques (ab externo vs. ab interno) and stent dimensions. These morphological differences should be taken into consideration when evaluating blebs, as they could impact assessments of bleb functionality and influence decisions regarding postoperative interventions.
评估滤过泡形态是青光眼滤过性手术成功的重要组成部分。PRESERFLO微型分流器（PRESERFLO）和XEN凝胶支架（XEN）是采用不同手术入路（分别为外路和内路）植入的引流装置，这可能导致滤过泡形态不同。了解这些形态差异对于术后护理至关重要。在本研究中，我们使用高分辨率眼前节光学相干断层扫描（OCT）成像对PRESERFLO和XEN植入术后的功能性滤过泡进行了回顾性研究。利用耶拿滤过泡分级系统进行定性评估，并对代表滤过泡尺寸的12个参数进行定量评估，然后比较两组结果。共纳入80例患者的80只眼（PRESERFLO术后41只，XEN术后39只）。与XEN相比，PRESERFLO术后的功能性滤过泡出现高反射性Tenon改变的频率更高（分别为31.7%和10.3%，P = 0.02），海绵状改变的频率更低（17.1%和35.9%，P = 0.05）。此外，PRESERFLO滤过泡出现可见巩膜湖的频率更高（92.7%和30.8%，P < 0.001）。此外，PRESERFLO滤过泡的高度更大（2.13±0.5 vs. 1.85±0.6 mm，P = 0.03）、宽度更大（10.31±2.3 vs. 9.1±2.3 mm，P = 0.02）、长度更长（9.13±1.8 vs. 8.24±1.9 mm，P = 0.04）、相对于角膜缘的后位距离更远（6.21±1.2 vs. 5.21±1.8 mm，P = 0.005），且滤过泡壁更厚（1.60±0.5 vs. 1.1±0.4 mm，P = 0.004）。PRESERFLO和XEN术后的功能性滤过泡表现出形态差异，这可能归因于手术技术（外路与内路）和支架尺寸的不同。在评估滤过泡时应考虑这些形态差异，因为它们可能影响对滤过泡功能的评估，并影响术后干预的决策。
