Hayashi Eye Hospital, 4-23-35, Hakataekimae, Hakata-ku, Fukuoka, 812-0011, Japan.
Department of Anatomy, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
Jpn J Ophthalmol. 2023 Nov;67(6):685-692. doi: 10.1007/s10384-023-01014-6. Epub 2023 Aug 4.
This study aimed to introduce a new technique for lowering intraocular pressure (IOP) using a multi-stent system after the implantation of a Baerveldt glaucoma implant (BGI) and evaluate its clinical effectiveness.
Prospective case series.
Six patients with uncontrolled refractory glaucoma were enrolled between December 2021 and May 2022. Six 6-0 nylon sutures were preoperatively inserted into the tube of a BGI. These sutures were named "comet stents" (CSs). BGI implantation was performed, and the CSs were removed one-by-one whenever the IOP rose during the follow-up period. IOP was measured 30-60 min after the removal of each CS, and the reduction in IOP was recorded to assess the effect of CS removal. IOP reduction and the effect of CS removal on IOP reduction were evaluated for 6 months. The cut and trimmed stented tubes were examined with scanning electron microscopy, and the ratio of the patent cross-sectional area to the total luminal area (PCSA, %) and the luminal area occupation rate per stent (%) were calculated.
The mean (±standard deviation) IOP decreased from 31.5 ± 2.8 mmHg at the baseline to 14.8 ± 8.3 mmHg at 1 month, 8.8 ± 4.7 mmHg at 3 months, and 9.2 ± 3.4 mmHg at 6 months. The IOP reduction induced by CS removal ranged from 0 to 19 mmHg. The mean PCSA was 52.7 ± 1.7%, and the mean luminal area occupation rate per stent was 7.9 ± 0.3%.
The use of CSs is an effective technique for controlling IOP in a step-by-step manner after BGI surgery.
本研究旨在介绍一种在植入 Baerveldt 青光眼引流管（BGI）后使用多支架系统降低眼内压（IOP）的新技术，并评估其临床效果。
前瞻性病例系列研究。
2021 年 12 月至 2022 年 5 月期间，共纳入 6 例难治性青光眼控制不佳的患者。在 BGI 管内预先插入 6 根 6-0 尼龙缝线，这些缝线被命名为“彗星支架”（CS）。行 BGI 植入术，在随访期间眼压升高时，逐一取出 CS。取出 CS 后 30-60 分钟测量眼压，并记录眼压下降情况，以评估 CS 去除的效果。评估 CS 去除对眼压的影响，观察 6 个月的眼压降低情况。用扫描电子显微镜检查切割和修剪后的支架管，计算支架管的有效管腔面积与总面积之比（PCSA，%）和每根支架管腔面积占有率（%）。
平均（±标准差）眼压从基线时的 31.5±2.8mmHg 降至 1 个月时的 14.8±8.3mmHg、3 个月时的 8.8±4.7mmHg 和 6 个月时的 9.2±3.4mmHg。CS 去除引起的眼压降低范围为 0 至 19mmHg。平均 PCSA 为 52.7±1.7%，每根支架管腔面积占有率为 7.9±0.3%。
在 BGI 手术后，CS 的使用是一种控制 IOP 的有效技术，可以逐步进行。
