Efficacy and Safety of the Ab-interno Xen Gel Stent After Failed Trabeculectomy
Efficacy and Safety of the Ab-interno Xen Gel Stent After Failed Trabeculectomy
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DOI：
10.1097/ijg.0000000000001044
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发表时间：
2018-10-01
影响因子：
2
通讯作者：
Lindfield, Dan
中科院分区：
文献类型：
--
作者：
Karimi, Ayesha;Hopes, Marina;Lindfield, Dan
目的：评估Xen凝胶支架在降低既往小梁切除术失败患者眼内压（IOP）方面的有效性和安全性，并确定并发症的发生率和进一步干预措施。方法：回顾性病例记录回顾性分析了2015年8月至2017年5月5家中心接受Xen手术的所有既往小梁切除术患者。结果：共回顾了17例手术。眼压从术前的21.5（+/- 2.4）mm Hg降至术后12个月的13.6（+/- 3.4）mm Hg（P < 0.05）。药物使用从术前的2.8（+/- 0.6）减少到12个月时的1.0（+/- 1.3）（P < 0.05）。不良事件包括：4例（23.5%）数值低眼压（IOP < 6 mm Hg）均自发消退，2例（11.8%）IOP峰值>= 30 mm Hg，1例（5.9%）植入物被虹膜短暂闭塞。2例（11.8%）病例需要二次滤过手术（Baerveldt管植入）。9例（52.9%）需要术后滤过泡干预，通常在术后第一个月。结论：Xen降低眼压和药物治疗失败的小梁切除术的眼睛。需要进行详细的术前结膜评估和靶向支架置入。需要前瞻性数据和超过12个月的随访，但Xen似乎是小梁切除术失败后可行、有效和安全的选择。
Aims: To assess the efficacy and safety of the Xen gel stent in reducing intraocular pressure (IOP) in eyes with prior failed trabeculectomy and to determine the frequency of complications and further intervention.Methods: Retrospective case note review of all patients with prior trabeculectomy undergoing Xen surgery across 5 centers from August 2015 to May 2017.Results: In total, 17 surgeries were reviewed. IOP reduced from 21.5 (+/- 2.4) mm Hg preoperatively to 13.6 (+/- 3.4) mm Hg at month 12 (P < 0.05). Medication usage reduced from 2.8 (+/- 0.6) preoperatively to 1.0 (+/- 1.3) at month 12 (P < 0.05). Adverse events included: numerical hypotony (IOP < 6 mm Hg) in 4 cases (23.5%) that all resolved spontaneously, IOP spike of >= 30 mm Hg in 2 (11.8%) cases and transient occlusion of the implant by iris in 1 (5.9%) case. Secondary filtration surgery (Baerveldt tube implantation) was required in 2 (11.8%) cases. Postoperative bleb intervention was required in 9 cases (52.9%), usually in the first month after surgery.Conclusions: Xen reduces IOP and number of medications in eyes with failed trabeculectomy. Detailed preoperative conjunctival assessment and targeted stent placement is required. Prospective data and follow-up beyond 12 months are required but Xen seems a viable, effective, and safe option after failed trabeculectomy.