Lentz P Connor, Wagner Isabella V, Draper Christian, Ang Bryan, Boopathiraj Nithya, Miller Darby, Dorairaj Syril
Ophthalmology, Mayo Clinic Alix School of Medicine, Jacksonville, USA.
Ophthalmology, Mayo Clinic, Jacksonville, USA.
Cureus. 2024 Jul 28;16(7):e65582. doi: 10.7759/cureus.65582. eCollection 2024 Jul.
Purpose XEN45 Gel Stent and glaucoma drainage device (GDD) implantation is safe and effective for glaucoma treatment and should be taught during glaucoma fellowship training. However, complications may still occur, with potentially sight-threatening consequences. The purpose of this study is to describe the management of complications following a series of XEN45 Gel Stent and GDD surgeries performed over the course of glaucoma fellowship training. Methods This is a retrospective case series of XEN45 Gel Stent surgeries performed on 16 eyes and GDD surgeries performed on seven eyes. Patient demographics, disease characteristics, and complications are reviewed. The intra- and postoperative course of five select cases with complications are described in detail. Results The most frequent complications following XEN45 implantation were transient hypotony (10 eyes, 63%), reduced visual acuity (VA) (five eyes, 31%), choroidal effusion (three eyes, 19%), hyphema (two eyes, 13%), and intraocular pressure (IOP) spike (two eyes, 13%). Thirteen eyes (81%) required bleb needling, and three eyes (19%) required XEN45 replacement. Complications following GDD implantation included hypotony (three eyes, 43%), reduced VA (two eyes, 29%), choroidal effusion (two eyes, 29%), IOP spike (two eyes, 29%), implant exposure (two eyes, 29%), and shallow anterior chamber (one eye, 14%). Three eyes (43%) required revision or explantation with a secondary glaucoma surgery. One choroidal effusion following XEN45 surgery and one following GDD surgery were hemorrhagic choroidal effusions requiring surgical drainage. Conclusion Significant and potentially sight-threatening complications may occur following XEN45 Gel Stent and GDD implantation performed over the course of fellowship training. Glaucoma fellows should be ably equipped to recognize, diagnose, and manage these complications both intra- and postoperatively.
目的 XEN45凝胶支架和青光眼引流装置（GDD）植入术对于青光眼治疗是安全有效的，应在青光眼专科培训期间进行传授。然而，并发症仍可能发生，并可能产生威胁视力的后果。本研究的目的是描述在青光眼专科培训过程中进行的一系列XEN45凝胶支架和GDD手术之后并发症的处理情况。方法 这是一项回顾性病例系列研究，包括对16只眼进行的XEN45凝胶支架手术和对7只眼进行的GDD手术。回顾了患者的人口统计学资料、疾病特征和并发症情况。详细描述了5例有并发症的精选病例的术中及术后过程。结果 XEN45植入术后最常见的并发症是短暂性低眼压（10只眼，63%）、视力下降（VA）（5只眼，31%）、脉络膜积液（3只眼，19%）、前房积血（2只眼，13%）和眼压（IOP）峰值（2只眼，13%）。13只眼（81%）需要进行滤过泡针刺，3只眼（19%）需要更换XEN45。GDD植入术后的并发症包括低眼压（3只眼，43%）、视力下降（2只眼，29%）、脉络膜积液（2只眼，29%）、眼压峰值（2只眼，29%）、植入物暴露（2只眼，29%）和前房浅（1只眼，14%）。3只眼（43%）需要进行翻修或取出并进行二次青光眼手术。XEN45手术后1例脉络膜积液和GDD手术后1例脉络膜积液为出血性脉络膜积液，需要手术引流。结论 在专科培训过程中进行XEN45凝胶支架和GDD植入术后可能会发生严重且可能威胁视力的并发症。青光眼专科医生应具备在术中及术后识别、诊断和处理这些并发症的能力。
