目的:关于一般青光眼治疗和早期微创和微切口手术的建议是有限的。这项研究旨在建立关于青光眼管理的共识,专注于XEN-45凝胶支架植入。
方法:使用Delphi共识驱动过程。科学委员会领导了这项研究,确定了专家小组,并参与制定问卷。51名小组成员被邀请完成,在李克特的九分尺度上,包含三个主题块的89项问卷。进行了两轮Delphi。如果≥66.6%的小组成员达成一致或分歧,则达成共识。
结果:小组成员就84个与患者生活质量相关的项目达成一致,治疗算法和患者概况,以及手术和手术前后的管理。小组成员同意XEN支架植入物在不同阶段和不同患者情况下治疗青光眼的适用性:年轻患者,老年人或有明显合并症,患有近视性青光眼,以前手术失败的病人,和以前可怜的术后经验。XEN手术被认为是经典滤过手术之前的治疗步骤,并且是合并疾病和不受控制的眼压的老年患者的可能的第一手术选择。XEN手术使患者能够比常规过滤手术更快地恢复日常活动,并减少和/或消除局部治疗。
结论:这个德尔菲驱动的共识产生了一系列青光眼治疗的一般建议,包括那些与患者生活质量有关的,治疗算法,和病人资料,以及关于XEN支架凝胶手术的具体使用。
OBJECTIVE: Recommendations on general glaucoma management and the use of early minimally invasive and microincisional surgeries are limited. This study aimed to establish
consensus regarding glaucoma management, focusing on the XEN-45 gel stent implant.
METHODS: A Delphi
consensus-driven process was used. The scientific committee led the study, identified the expert panel, and participated in elaborating the questionnaire. Fifty-one panelists were invited to complete, on a nine-point Likert scale, an 89-item questionnaire covering three topic blocks. Two Delphi rounds were performed.
Consensus was achieved if ≥66.6% of panelists reached agreement or disagreement.
RESULTS: Panelists agreed on 84 items related to the patients\' quality of life, the therapeutic algorithm and patient profile, and surgical and pre- and post-operative management. Panelists agreed on the suitability of XEN stent implants to treat glaucoma at different stages and for different patient profiles: young patients, elderly or with significant comorbidities, and with myopic glaucoma, patients who failed previous surgeries, and with previous poor post-operative experience. XEN surgery was considered a therapeutic step prior to classic filtering surgery and a possible first surgical option in elderly patients with comorbidities and uncontrolled intraocular pressure. XEN surgery allows the patient to return to routine daily activities faster than conventional filtering surgeries and to reduce and/or eliminate topical treatments.
CONCLUSIONS: This Delphi-driven
consensus resulted in a series of general recommendations for glaucoma management, including those related to patient quality of life, therapeutic algorithm, and patient profile, and specific ones regarding the use of XEN stent gel surgery.