Comparison of Clinical Outcomes Following Gel Stent Implantation via Ab-Externo and Ab-Interno Approaches in Patients with Refractory Glaucoma.
Comparison of Clinical Outcomes Following Gel Stent Implantation via Ab-Externo and Ab-Interno Approaches in Patients with Refractory Glaucoma.
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DOI：
10.2147/opth.s354038
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发表时间：
2022
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比较经外路和内路凝胶支架植入术治疗难治性青光眼的临床效果。这项回顾性研究纳入了185例年龄≥45岁的患者203只眼，这些患者接受了Xen凝胶支架植入术，作为独立手术治疗医学上不受控制的青光眼（眼内压(IOP)≥18 mmHg），尽管使用了最大可耐受的降眼压药物。105只眼经内入路行凝胶支架植入术，98只眼经外入路行凝胶支架植入术。既往有结膜切口青光眼或白内障手术的患者也包括在内。研究参数为术后3、6、9和12个月的IOP降低和降低IOP药物的数量。两组患者的年龄、性别、术前IOP、降眼压药物用量、杯盘比基线比较差异均无统计学意义（p < 0.05）。在所有的术后时间点，两组的平均IOP和从基线下降的百分比具有可比性（p < 0.05），但在术后6个月时，外置组的结果明显更好（p < 0.05）。两组患者术后手术（5-氟尿嘧啶注射和水泡针）的发生率、数值或临床低血压和不良事件的发生率具有可比性（p < 0.05）。两组在所有时间点的平均降血压药物数量是相当的。Xen凝胶支架，无论是内植入还是外植入，都能有效降低难治性青光眼患者的IOP和对局部药物的依赖。该支架可用于晶状体和假性晶状体患者，对于先前小梁切除术失败的患者是一种合理的选择。
To compare clinical outcomes following gel stent implantation via ab externo and ab interno approaches in patients with refractory glaucoma. This retrospective study included 203 eyes of 185 patients aged ≥45 years who underwent Xen gel stent implantation as a standalone procedure for medically uncontrolled glaucoma (intraocular pressure (IOP) ≥18 mmHg) despite maximum tolerable IOP-lowering medications. One hundred and five eyes underwent gel stent implantation via ab interno approach and 98 via ab externo. Patients with prior conjunctival-incisional glaucoma or cataract surgery were also included. Study parameters were reduction in IOP and number of IOP-lowering medications from baseline to 3, 6, 9 and 12 months postoperatively. There were no statistically significant differences in the age, sex, preoperative IOP, number of IOP-lowering medications or cup–disc ratio between the ab interno and ab externo groups at baseline (p > 0.05). At all postoperative time points, mean IOP and percentage reduction from baseline were comparable in both groups (p > 0.05) except at postoperative 6 months when the outcomes were significantly better (p < 0.05) in the ab externo group. The rate of postoperative procedures (5-Fluorouracil injections and bleb needling), the incidence of numerical or clinical hypotony and adverse events were comparable in both groups (p > 0.05). The mean number of IOP-lowering medications was comparable in both groups at all time points. The Xen gel stent, whether implanted ab interno or ab externo, is effective in reducing IOP and dependence on topical medications in eyes with refractory glaucoma. The stent may be used in both phakic and pseudophakic patients and is a reasonable option for patients with prior failed trabeculectomy.