XEN凝胶引流管植入术治疗青光眼的3年疗效观察

Three-year results of XEN gel stent implantation in the treatment of glaucoma

目的探讨XEN凝胶引流管植入术治疗青光眼的远期有效性和安全性。方法回顾性病例系列研究。收集2020年1至9月于福建医科大学附属第一医院就诊且由同一术者完成XEN凝胶引流管植入术的青光眼患者的临床资料, 记录术前和术后1 d、1周、1个月、2个月、3个月、6个月、12个月、18个月、24个月、36个月的眼压、降眼压药物使用数量、最佳矫正视力、手术成功情况、滤过泡情况、术后并发症等。采用方差分析、最小显著性差异法、Fisher精确概率检验等进行统计学分析。结果共纳入8例(8只眼)符合标准的青光眼患者, 其中男性6例(6只眼), 女性2例(2只眼)。术前眼压为(30.88±12.17)mmHg(1 mmHg=0.133 kPa), 术后各随访时间眼压均低于术前, 差异有统计学意义(P<0.05);术后3年眼压为(14.38±1.60)mmHg, 较术前下降(16.50±12.07)mmHg, 降幅为53.43%。术后3年仅2例患者使用1种降眼压药物, 7例患者最佳矫正视力无明显下降。术后3年手术完全成功6例, 条件成功1例, 手术失败1例;滤过泡均较为扁平弥散, 仅轻至中度血管化。1例患者在术后3个月出现眼压升高, 行XEN引流管再通术后使用曲伏前列腺素滴眼液控制眼压稳定。结论基于8例青光眼患者进行观察, XEN凝胶引流管植入术后3年可有效降低青光眼患者的眼压, 且具有较高的安全性。

ObjectiveTo evaluate the long-term efficacy and safety of XEN gel stent implantation in patients with refractory glaucoma.MethodsA retrospective case series study was conducted.Clinical data were collected from patients who received medical treatment at the First Affiliated Hospital of Fujian Medical University between January 2020 and September 2020 and underwent XEN gel stent implantation by the same surgeon.Preoperative and postoperative clinical parameters,including the intraocular pressure(IOP),number of ocular hypotensive medications,best-corrected visual acuity,surgical success rates,status of filtering blebs,and complications,were recorded at 1 day,1 week,1,2,3,6,12,18,24,and 36 months after surgery.Statistical analyses were performed using the analysis of variance(ANOVA),the least significant difference(LSD)method,and the Fisher′s precision probability test.ResultsA total of 8 patients(8 eyes)with glaucoma meeting the criteria were included,consisting of 6 males(6 eyes)and 2 females(2 eyes).The preoperative IOP reached(30.88±12.17)mmHg(1 mmHg=0.133 kPa),and the IOP at all postoperative follow-up time points was significantly lower than the preoperative value(P<0.05).At 3 years after surgery,the IOP was(14.38±1.60)mmHg,with a reduction of 53.43%[(16.50±12.07)mmHg].Only 2 patients required monotherapy for IOP control,and there was no significant decline in best-corrected visual acuity in 7 patients.The surgical outcome at 3 years postoperatively was a complete success in 6 patients,a qualified success in 1 patient,and a failure in 1 patient.The filtering blebs were generally flat and diffuse,with only mild to moderate vascularization.One patient presented elevated IOP at 3 months,and after a subsequent revision of the XEN gel stent,the IOP became stable with the administration of travoprost eye drops.ConclusionThe XEN gel stent implantation proved to effectively reduce the IOP in glaucoma patients,with a high degree of safety demonstrated up to 3-year long-term follow-up.