Corneal Parameters after Tube-Shunt Implantation through the Ciliary Sulcus
Corneal Parameters after Tube-Shunt Implantation through the Ciliary Sulcus
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DOI：
10.1016/j.ogla.2020.07.009
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发表时间：
2021-01-22
影响因子：
2.9
通讯作者：
Weiner, Asher
中科院分区：
文献类型：
--
作者：
Weiner, Adam J.;Weiner, Yotam;Weiner, Asher
目的：监测单侧经睫状沟植入Baerveldt 350管分流术(Advanced Medical Optics，Santa Ana，CA)后的双侧角膜参数。设计：回顾性干预性病例系列。参与者：1例自发性青光眼严重失控性青光眼患者行人工晶状体植入术1只眼。方法：收集手术患者和青光眼对侧眼在单侧角膜沟管分流术植入前后的镜检数据。主要观察指标：中央角膜内皮细胞密度(CEcD)、变异系数(CV)、六角形细胞百分比、中央角膜厚度(CCT)、眼内压(IOP)、眼内压(IOP)、眼内压(IOP)结果：46例患者(平均年龄69.9岁；标准差[SD]，4.6岁；范围20-88岁；男性，41.3%)。手术眼组术后眼压下降42.3%(P<；0.0001)，降眼压药物减少32.1%(P<；0.0001)。手术眼和对侧眼CEcD分别为1807个/mm(2)和1825个/mm(2)(P=0.92)，术后24个月较术前分别下降8.6%(P=0.17)和3.1%(P=0.65)。两组的术前CV、六角形细胞百分比和CCT相似，并保持稳定。在术前CEcD低的15例患者中，所有角膜参数没有变化(1273个/mm(2)；SD，99个/mm(2))。两组最佳矫正视力均保持稳定。23.9%的手术眼发生前房积血，无需干预即可消失。我们在随访中没有发现威胁视力的并发症或角膜衰竭。结论：人工晶状体眼经睫状沟植入管状分流术对角膜内皮相对安全，中央CEcD较基线和青光眼对侧眼略有下降，且无显著差异。在24个月的随访期内，没有发现明显的角膜内皮细胞形态特征的破坏、角膜厚度的增加或角膜衰竭。有必要进行前瞻性的头对头比较，以评估不同的管分流植入方法对角膜内皮的影响。(C)2020年由美国眼科学会颁发
Purpose: To monitor bilateral corneal parameters after unilateral Baerveldt 350 tube-shunt implantation (Advanced Medical Optics, Santa Ana, CA) through the ciliary sulcus.Design: Retrospective, interventional case series.Participants: Patients from 1 private glaucoma practice with severe uncontrolled glaucoma treated with sulcus tube-shunt implantation in 1 pseudophakic eye.Methods: Specular microscopy data were collected before and after unilateral sulcus tube-shunt implantation from the surgical and the glaucomatous fellow eyes.Main Outcome Measures: Central corneal endothelial cell density (CECD), coefficient of variation (CV), percent of hexagonal cells, central corneal thickness (CCT), intraocular pressure (IOP), IOP-lowering medications, visual acuity, and complications.Results: Forty-six patients (mean age, 69.9 years; standard deviation [SD], 4.6 years; range, 20-88 years; male gender, 41.3%) were identified. After surgery, IOP and the number of IOP-lowering medications decreased significantly by 42.3% (P < 0.0001) and 32.1% (P < 0.0001), respectively, in the surgical eye group. Preoperative CECD measured 1807 cells/mm(2) (SD, 172 cells/mm(2)) and 1825 cells/mm(2) (SD, 172 cells/mm(2)) in the surgical and fellow eyes, respectively (P = 0.92), and compared with baseline, it decreased by 8.6% (P = 0.17) and 3.1 % (P = 0.65), respectively, by 24 months. Preoperative CV, percent of hexagonal cells, and CCT were similar in both groups and remained stable. All corneal parameters remained unchanged in a subgroup of 15 patients with low preoperative CECD (1273 cells/mm(2); SD, 99 cells/mm(2)). Best-corrected visual acuity remained stable in both groups. Hyphema occurred in 23.9% of the surgical eyes and resolved with no intervention. We found no sight-threatening complications or corneal failures during follow-up.Conclusions: Tube-shunt implantation through the ciliary sulcus in pseudophakic eyes appears relatively safe to the corneal endothelium, demonstrating a small and nonsignificant decline in central CECD compared with baseline and with glaucomatous fellow eyes. No significant disruption to corneal endothelial cell morphologic features, increased corneal thickness, or corneal failures were found during the 24-month follow-up period. A prospective head-to-head comparison to assess the effects of the various methods of tube-shunt implantation on the corneal endothelium is needed. (C) 2020 by the American Academy of Ophthalmology