Arzu AŞICI, Funda DIKKAYA, Mehmet Selim KOCABORA, Cemil YILMAZLI, Sevil Karaman ERDUR

Açık Açılı Glokom Tedavisinde ab interno Jel İmplant Kısa Dönem Sonuçlarının Retrospektif İncelenmesi

Amaç: Primer açık açılı glokom (PAAG) hastalarında 6 aylık takip sırasında preoperatif Mitomycin C enjeksiyonu ile Xen45 Jel Stent implantasyonunun göz içi basıncını(GİB) düşürme ve güvenlik profillerini değerlendirmek. Gereç ve Yöntemler: Fakoemülsifikasyon ile kombine XEN45 Jel Stent ile ameliyat edilen 13 PAAG hastasının 14 gözünün kayıtları retrospektif olarak değerlendirildi. Takip süresince GİB değişiklikleri, tüm komplikasyonlar ve ek işlemler değerlendirildi. Çalışmada birincil değerlendirilen sonuç GİB idi. Tam başarı için belirlenen GİB hedefi ameliyat öncesine göre %20’nin üzerinde bir düşüş ve herhangi bir glokom ilacı olmaksızın 6. ayda GİB≥6 ve ≤21 olarak tanımlandı. Yeterli başarı ise ilaçlı veya ilaçsız olarak 6. ayda GİB’de %20’den fazla azalma ve GİB≥6 ve ≤21 olarak tanımlandı. Bulgular: Ortalama preoperatif ilaçlı GİB, ortalama 2,6 ± 0,6 topikal anti-glokom molekülü ile beraber 28,4 ± 2,7 mmHg idi. Altı aylık takip süresinden sonra ortalama GİB, 0,4 ± 1,1 anti-glokom molekülü ile beraber 17,8 ± 1,5 mmHg’ye (ortalama GİB düşüşü %37) düştü. 6 ay sonra tam başarı oranı %42,8 ve yeterli başarı oranı %85,7 olarak bulundu. Toplamda sadece 2 hastaya (%14,2) ek işlem (1 iğneleme ve 1 trabekülektomi) gerekti. Sonuç: Çalışma, fako-katarakt cerrahisi ile kombine XEN45 Jel Stent implantasyonunun, kontrolsüz GİB durumunda olumlu güvenlik profili ve düşük komplikasyon oranı ile PAAG’da etkili bir cerrahi yöntem olabileceğini göstermiştir.

Retrospective Analysis of Short Term Outcomes with ab interno Gel Implant in the Treatment of Open Angle Glaucoma

Aim: To evaluate the intraocular pressure (IOP) lowering and safety profiles of the Xen45 Gel Stent implantation with preoperative Mitomycin C injection during a 6 months follow-up in patients with primary open-angle glaucoma (POAG). Material and Methods: Records of fourteen eyes of 13 POAG patients who underwent surgery with XEN45 Gel Stent combined with phacoemulsification were evaluated retrospectively. IOP changes, all complications and additional procedures during follow-up period were evaluated. Primary outcome measure was IOP, and the IOP target for complete success was defined as a postoperative IOP drop of more than 20% from preoperative baseline and IOP≥6 and ≤21 at 6 months without any glaucoma medications and qualified success was defined as a postoperative IOP reduction of more than 20% and IOP≥6 and ≤21 at 6 months with or without medications. Results: Mean preoperative medicated IOP was 28.4 ± 2.7 mmHg with a mean of 2.6 ± 0.6 topical anti- glaucoma molecules. After 6 month follow-up period, mean IOP decreased to 17.8 ± 1.5 mmHg (mean IOP reduction of 37%) on 0.4 ± 1.1 antiglaucoma molecules. The complete success rate after 6 months was achieved in 42.8% and qualified success in 85.7. Totally only 2 (14.2%) patients required additional procedure (1 needling and 1 trabeculectomy). Conclusion: The study showed that the XEN45 Gel Stent implantation combined with phaco-cataract surgery is an effective surgical method in POAG in case of uncontrolled IOP with a favorable safety profile and low complication rate.

PDF

___

1. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 2006;90:262- 267.
2. Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: A systematic review and meta-analysis. Ophthalmology 2014;121:2081-2090.
3. Watson PG, Jakeman C, Ozturk M, Barnett MF, Barnett F, Khaw KT. The complications of trabeculotomy (a 20-year follow-up). Eye (Lond) 1990;4:425-438.
4. Shute TS, Dietrich UM, Baker JFM, Carmichael KP, Wustenberg W, Ahmed IIK, Sheybani A. Biocompatibility of a novel microfistula implant in nonprimate mammals for the surgical treatment of glaucoma. Invest Ophthalmol Vis Sci 2016;57:3594-3600.
5. Lewis RA. Ab interno approach to the subconjunctival space using a collagen glaucoma stent. J Cataract Refract Surg 2014;40:1301-1306.
6. Sheybani A, Reitsamer H, K Ahmed IIK. Fluid dynamics of a novel micro-fistula implant for the surgical treatment of glaucoma. Invest Ophthalmol Vis Sci 2015;56:4789-4795.
7. Perez-Torregrosa VT, Olate-Pérez A, Cerdà-Ibáñez M, Gargallo-Benedicto A, Osorio-Alayo V, Barreiro-Rego A, Duch- Samper A. Combined phacoemulsification and XEN45 surgery from a temporal approach and 2 incisions. Arch Soc Esp Oftalmol 2016;91:415-421.
8. De Gregorio A, Pedrotti E, Russo L, Morselli S. Minimally invasive combined glaucoma and cataract surgery: Clinical results of the smallest ab interno gel stent. Int Ophthalmol 2018;38:1129-1134.
9. Karimi A, Lindfield D, Turnbull A, Dimitriou C, Bhatia B, Radwan M, Gouws P, Hanifudin A, Amerasinghe N, Jacob A. A multi- centre interventional case series of 259 ab-interno Xen gel implants for glaucoma, with and without combined cataract surgery. Eye (Lond) 2019;33:469-477.
10. Mansouri K, Guidotti J, Rao HL, Ouabas A, D’Alessandro E, Roy S, Mermoud A. Prospective Evaluation of Standalone XEN Gel Implant and Combined Phacoemulsification-XEN Gel Implant Surgery: 1-Year Results. J Glaucoma 2018;27:140- 147.
11. Galal A, Bilgic A, Eltanamly R, Osman A. XEN Glaucoma Implant with Mitomycin C 1-Year Follow-Up: Result and Complicaitons. J Ophthalmol 2017;2017:5457246.
12. Hohberger B, Welge-Lüßen UC, Lämmer R. MIGS: Therapeutic success of combined Xen Gel Stent implantation with cataract surgery. Graefes Arch Clin Exp Ophthalmol 2018;256:621-625.