Department of Ophthalmology, 3rd Faculty of Medicine, University Hospital Kralovske Vinohrady.
Department of Medical Biophysics and Informatics, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.
J Glaucoma. 2024 Sep 1;33(9):686-695. doi: 10.1097/IJG.0000000000002380. Epub 2024 Apr 1.
Deep sclerectomy (DS) with fibrin adhesive can constitute a safe alternative to the classic procedure using sutures, providing nonallergenic, nontoxic, and secure adhesion with no sign of aqueous humor outflow obstruction postoperatively.
To evaluate short and medium-term postoperative results of DS with a fibrin sealant.
This prospective, noncomparative, interventional case series involves 12 eyes of 12 patients with uncontrolled open angle glaucoma who underwent DS with Esnoper (Clip or V2000) implant between February 2021 and March 2022. A novel method of wound closure (sclera, Tenon fascia, and conjunctiva) employing fibrin glue was used instead of classic sutures. Surgical outcomes assessed include: intraocular pressure and glaucoma therapy reduction, best-corrected visual acuity changes, and number of complications registered peri and postoperatively. All measurements were performed preoperatively, as well as at 1 day, at 1 and 2 weeks, and at 1, 2, 3, 6, 9, and 12 months after surgery.
The mean intraocular pressure decreased from 24.0 ± 9.1 mm Hg to 13.8 ± 6.3 mm Hg at 1 year postoperatively ( P < 0.001). Kaplan-Meier survival analysis revealed complete and qualified success rates of 83.3% and 91.7%. The mean glaucoma therapy decreased from 3.2 ± 1.1 to 0.8 ± 1.3 drugs 12 months after surgery ( P < 0.001). Nd:YAG goniopunture was performed in 2 eyes at 1 and 12 months postoperatively. No significant best-corrected visual acuity changes were registered. Perioperatively, we noted a trabeculo-descemet microperforation in 1 eye, transient hypotony in 5 eyes, and mild hyphema in 2 eyes.
Fibrin adhesive provided an effective closure in sutureless DS in the patients included in our study. This modification of classical DS may simplify the surgical technique, ensure secure wound adaptation, optimize healing, and lower the risk of inflammation and fibrosis postoperatively.
与纤维蛋白胶联合的深层巩膜切除术（DS）可以构成经典缝线手术的安全替代方案，提供非变应原性、无毒且安全的黏附，术后无房水流出阻塞的迹象。
评估使用纤维蛋白密封剂进行 DS 的短期和中期术后结果。
这项前瞻性、非对照、干预性病例系列研究纳入了 2021 年 2 月至 2022 年 3 月期间接受 Esnoper（Clip 或 V2000）植入物进行 DS 的 12 例 12 只眼的患者。采用一种新的伤口闭合方法（巩膜、Tenon 筋膜和结膜），使用纤维蛋白胶代替经典缝线。评估的手术结果包括：眼压和青光眼治疗的降低、最佳矫正视力的变化以及术后和围手术期登记的并发症数量。所有测量均在术前、术后 1 天、1 周和 2 周以及术后 1、2、3、6、9 和 12 个月进行。
平均眼压从 24.0 ± 9.1mmHg 降低至术后 1 年的 13.8 ± 6.3mmHg（P < 0.001）。Kaplan-Meier 生存分析显示完全和合格成功率分别为 83.3%和 91.7%。术后 12 个月，平均青光眼治疗从 3.2 ± 1.1 降至 0.8 ± 1.3 种药物（P < 0.001）。Nd:YAG 后房角切开术在术后 1 个月和 12 个月对 2 只眼进行。未观察到明显的最佳矫正视力变化。术中我们注意到 1 只眼出现小梁 - 角膜微穿孔，5 只眼出现短暂性眼压降低，2 只眼出现轻度前房积血。
纤维蛋白胶在我们研究中的患者中提供了无缝线 DS 的有效闭合。这种对经典 DS 的改进可能简化手术技术，确保安全的伤口适应，优化愈合，并降低术后炎症和纤维化的风险。
