C Amarasekera Dilru, A Shankar Vikram, Razeghinejad Reza
Wills Eye Hospital, Philadelphia, Pennsylvania, USA.
Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.
J Ophthalmic Vis Res. 2024 Sep 16;19(3):386-391. doi: 10.18502/jovr.v19i3.9404. eCollection 2024 Jul-Sep.
To discuss four cases of post-operative XEN gel stent luminal obstruction in patients with primary open angle glaucoma.
Four eyes in three patients with primary open angle glaucoma who received XEN stent implantation were found to have luminal obstruction of their stents. Stent obstruction can mimic filtering bleb failures not responding to bleb needling and antimetabolite injections. These obstructions were suspected to result from fibrin clots, iris pigment granules, or breakdown products of intraocular inflammation or hemorrhage. Treatment options trialed in these patients included bleb needling, 5-fluorouracil injection, and YAG laser to the proximal end of the XEN. Ultimately, all four eyes required XEN explantation and alternative filtering surgery.
XEN luminal obstruction is an important complication of stent placement that can ultimately lead to stent failure. Conservative measures such as laser or traditional bleb management may be considered before stent explantation or additional glaucoma surgery.
探讨4例原发性开角型青光眼患者术后XEN凝胶支架管腔阻塞的情况。
3例接受XEN支架植入术的原发性开角型青光眼患者的4只眼中发现支架管腔阻塞。支架阻塞可表现为类似对滤过泡针刺和抗代谢药物注射无反应的滤过泡失败。这些阻塞被怀疑是由纤维蛋白凝块、虹膜色素颗粒或眼内炎症或出血的分解产物引起的。在这些患者中尝试的治疗选择包括滤过泡针刺、5-氟尿嘧啶注射以及对XEN近端进行YAG激光治疗。最终，所有4只眼均需要取出XEN并进行替代性滤过手术。
XEN管腔阻塞是支架置入的一种重要并发症，最终可导致支架失败。在取出支架或进行额外的青光眼手术之前，可考虑采取激光或传统滤过泡处理等保守措施。
