Jin Sean J, Kim Sharon Y, Tallo Jared, Rana Harkaran S, Raiciulescu Sorana, Oguntoye-Ouma Morohunranti O, Kim Won I
Department of Ophthalmology, San Antonio Military Medical Center, San Antonio, TX 78234, USA.
School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA.
J Clin Med. 2025 Jun 21;14(13):4426. doi: 10.3390/jcm14134426.
This study evaluated the efficacy and safety of the ab externo open-conjunctiva (AEO) approach with adjunctive Ologen collagen matrix (OCM) compared to ab interno closed-conjunctiva (AIC) techniques for XEN45 gel stent implantation in patients with refractory open-angle glaucoma. The goal was to determine whether the AEO with OCM approach offers advantages in intraocular pressure (IOP) control and postoperative outcomes. A retrospective, comparative case series was conducted on 76 eyes from 76 patients with open-angle glaucoma who underwent XEN45 implantation between 2017 and 2022 at a single tertiary center. The patients were divided into Group 1 (AEO with OCM, n = 47) and Group 2 (AIC, n = 29). Postoperative IOP, the number of glaucoma medications, surgical complications, bleb revisions, and failure rates were recorded over 12 months. The AEO technique, supported by OCM, was assessed for its potential to reduce postoperative fibrosis and improve long-term outcomes. Both groups experienced significant IOP reductions over time compared to baseline. However, Group 1 had superior outcomes, requiring fewer glaucoma medications postoperatively ( < 0.05), and demonstrated lower rates of complications (10.6% vs. 31.0%, = 0.026) and bleb revisions (8.5% vs. 34.5%, = 0.005). Kaplan-Meier survival analysis showed significantly greater cumulative surgical success in Group 1 compared to Group 2 ( < 0.001). The AEO with OCM approach to XEN45 implantation may provide improved safety and efficacy compared to the AIC approach. It appears to be beneficial in minimizing postoperative fibrosis, reducing the medication burden, and lowering complication and failure rates. Prospective randomized trials are needed to validate these findings.
本研究评估了外路开放式结膜（AEO）联合奥洛根胶原基质（OCM）方法与内路封闭式结膜（AIC）技术在难治性开角型青光眼患者中植入XEN45凝胶支架的有效性和安全性。目的是确定AEO联合OCM方法在眼压（IOP）控制和术后结果方面是否具有优势。对2017年至2022年在单个三级中心接受XEN45植入的76例开角型青光眼患者的76只眼睛进行了一项回顾性、比较性病例系列研究。患者分为第1组（AEO联合OCM，n = 47）和第2组（AIC，n = 29）。记录12个月内的术后眼压、青光眼药物使用数量、手术并发症、滤泡修复情况和失败率。评估了在OCM支持下的AEO技术减少术后纤维化和改善长期结果的潜力。与基线相比，两组患者的眼压均随时间显著降低。然而，第1组的结果更好，术后所需的青光眼药物更少（<0.05），并发症发生率更低（10.6%对31.0%，=0.026），滤泡修复率更低（8.5%对34.5%，=0.005）。Kaplan-Meier生存分析显示，第1组的累积手术成功率显著高于第2组（<0.001）。与AIC方法相比，采用AEO联合OCM方法植入XEN45可能会提高安全性和有效性。它似乎有利于减少术后纤维化、减轻药物负担以及降低并发症和失败率。需要进行前瞻性随机试验来验证这些发现。
