改良外路XEN凝胶支架植入术治疗晚期青光眼的有效性及安全性  

Efficacy and Safety of Modified Ab Externo XEN Gel Stent Implantation for Advanced Glaucoma

作　　者：谢佩纭 王艺霏 金铃菲 李婷婷 李秋雨[1] 李军花 Xie Peiyun;Wang Yifei;Jin Lingfei;Li Tingting;Li Qiuyu;Li Junhua(Wenzhou Medical University,Wenzhou 325035,China;National Clinical Research Center for Ocular Diseases,Eye Hospital,Wenzhou Medical University,Wenzhou 325027,China)

机构地区：[1]温州医科大学,温州325035 [2]温州医科大学附属眼视光医院,国家眼耳鼻喉疾病临床医学研究中心(眼部疾病),温州325027

出　　处：《中华眼视光学与视觉科学杂志》2025年第2期134-140,共7页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：温州市基础性科研项目(Y2023810)。

摘　　要：目的:评估改良外路XEN凝胶支架植入术治疗晚期青光眼的有效性及安全性。方法:回顾性系列病例研究。连续纳入2021年12月至2023年4月于温州医科大学附属眼视光医院确诊为晚期青光眼并接受改良外路XEN凝胶支架植入术的患者12例(15眼),其中POAG 4例(6眼),PACG 1例(1眼),继发性青光眼(SG)7例(8眼)。收集并分析患者术前,术后1周及1、3、6、12个月和末次随访的视力、眼压、降眼压药物数量、滤过泡形态、引流管位置、前房深度、手术并发症等。采用Wilcoxon符号秩和检验比较手术前后眼压和降眼压药物数量变化。采用Spearman相关性分析探讨结膜下注药和滤过泡针拨开始时间与干预次数、降压幅度的关系,并分析结膜下注药、滤过泡针拨、包裹壁分离切除及手术成功的影响因素。使用Kaplan-Meier生存分析曲线分析手术成功率。结果:随访时间18.0(17.0,27.0)个月。末次随访时眼压由术前最高值的25.0(20.4,41.5)mmHg(1 mmHg=0.133 kPa)下降至14.0(11.6,16.2)mmHg(Z=-2.95,P=0.003),局部降眼压药物数量由4.0(2.0,4.0)种减少为0.0(0.0,2.0)种(Z=-3.21,P=0.001)。术后18个月的手术总体成功率为87%,完全成功率为55%。手术成功、术后滤过泡干预与各影响因素均无相关性(均P>0.05)。2眼分别于术后2个月和7个月再次行抗青光眼手术。术后并发症主要包括睫状体脱离(7/15)、浅前房(5/15)和引流管内口阻塞(3/15)。所有术眼均未出现严重并发症。结论:改良外路XEN凝胶支架植入术可以显著降低术眼眼压和减少降眼压药物数量,在晚期青光眼的治疗中有较高的成功率和安全性。Objective:To assess the efficacy and safety of modified ab externo implantation of the XEN gel stent in patients with advanced glaucoma.Methods:This was a retrospective case series study.A total of 12 patients(15 eyes)diagnosed with advanced glaucoma undergoing modified ab externo XEN gel stent implantation between December 2021 to April 2023 at the Eye Hospital,Wenzhou Medical University were included.Among them,4 patients(6 eyes)had POAG,1 patient(1 eye)had PACG,and 7 patients(8 eyes)with secondary glaucoma(SG).Clinical data,including visual acuity,IOP,number of IOP-lowering medications,morphology of filtering blebs,position of the XEN gel stents,anterior chamber depth,surgical complications were collected and analyzed preoperatively and postoperatively at 1 week,1 month,3 months,6 months,12 months,and at the final follow-up.The Wilcoxon signed-rank test compared pre-and postperative changes in IOP and the number of IOP-lowering medications.Spearman correlation analysis evaluated associations between subconjunctival injection and bleb needling timing with intervention frequency and IOP reduction,along with factors influencing subconjunctival injection,bleb needling,open bleb revision,and surgical success.Kaplan-Meier survival analysis evaluated surgical success rate.Results:The median follow-up duration was 18.0(17.0,27.0)months.At the final follow-up,IOP decreased from a preoperative maximum of 25.0(20.4,41.5)mmHg to 14.0(11.6,16.2)mmHg(Z=-2.95,P=0.003),and the number of IOP-lowering medications decreased from 4.0(2.0,4.0)to 0.0(0.0,2.0)(Z=-3.21,P=0.001).The overall surgical success rate at 18 months was 87%,with a complete success rate of 55%.No significant correlations were found between surgical success or postoperative bleb interventions and the analyzed factors(all P>0.05).Two eyes required additional glaucoma surgery at 2 and 7 months postoperatively.Postoperative complications included ciliary body detachment(7/15),shallow anterior chamber(5/15),and blocked stent(3/15).No severe complications,such as vi

关 键 词：青光眼 XEN凝胶支架 外路植入 微创青光眼手术 眼内压 

分 类 号：R779.6[医药卫生—眼科]