Intraocular Pressure Reduction after Phacoemulsification: A Matched Cohort Study.
Intraocular Pressure Reduction after Phacoemulsification: A Matched Cohort Study.
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DOI：
10.1016/j.ogla.2020.10.002
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发表时间：
2021-05
影响因子：
--
通讯作者：
Herrinton LJ
中科院分区：
文献类型：
--
作者：
Carolan JA;Liu L;Alexeeff SE;Amsden LB;Shorstein NH;Herrinton LJ
超声乳化术与青光眼、高眼压、解剖学窄角和疑似青光眼（以下简称“青光眼”）患者的眼内压（IOP）降低有关，但报告的变化幅度各不相同。回顾性队列研究。将2010年6月至2015年5月接受超声乳化（“手术”）的青光眼患者与未接受超声乳化（“非手术”）的患者在年龄、性别、青光眼类型、基线IOP以及青光眼药物的数量和类型方面进行一对一匹配。使用电子病历信息比较匹配的手术组和非手术组。IOP变化、青光眼药物数量变化和超声乳化术后36个月内青光眼手术的可能性。可用时，通过Goldmann压平眼压测量法（45%）获得IOP测量值，否则通过Icare、Tono-pen、非接触式眼压测量法和肺眼压测量法获得IOP测量值。在16，169对匹配配对中，在随访至36个月期间，手术组在索引日期后的平均IOP低于非手术组。差异在1-18个月期间最大，在此期间，非手术患者的平均IOP从16.49 mm Hg增加0.22 mm Hg，手术患者的平均IOP从16.50 mm Hg降低0.99 mm Hg（差异中差异，1.21，95% CI 1.12-1.30 mm Hg）。高眼压患者（2.00 mm Hg）和术前IOP ≥20的患者（2.46 mm Hg）的差异最大。仅使用Goldmann压平眼压测量法对匹配患者进行亚组分析，发现了相似的结果。到30-36个月时，使用眼科药物的手术患者减少了5%（95% CI 4-6%）。在手术组中，高眼压患者选择性激光小梁成形术的几率降低（比值比[OR]，0.27; 95% CI 0.10-0.74）或疑似青光眼（OR，0.31; 95%CI 0.20-0.47），而原发性开角型青光眼手术患者的青光眼手术几率升高（OR，1.48; 95% CI 1.08-2.01）。在这项以社区为基础的研究中，白内障超声乳化术与IOP降低的相关性低于过去以社区为基础的研究。对于术前IOP小于20 mmHg的患者，外科医生应期望通过超声乳化术将眼压降低约1-2 mmHg。在这项以社区为基础的青光眼患者和中度正常IOP的青光眼可疑患者研究中，白内障超声乳化术与IOP降低的相关性低于过去以眼科为基础的研究报告。外科医生应该期望通过超声乳化术将眼内压降低约1-2 mmHg。
Phacoemulsification has been linked to lowered intraocular pressure (IOP) in patients with glaucoma, ocular hypertension, anatomic narrow angles, and in glaucoma suspects (henceforth, “glaucoma”), but the reported magnitude of change has varied. Retrospective cohort study. Patients with glaucoma, June 2010 to May 2015, who underwent phacoemulsification (“surgical”) were matched one-to-one to patients who did not (“non-surgical”) on age, gender, type of glaucoma, baseline IOP, and number and type of glaucoma medications. Electronic medical record information was used to compare the matched surgical and non-surgical groups. Change in IOP, change in number of glaucoma medications, and likelihood of a glaucoma procedure within 36 months after phacoemulsification. IOP measures were obtained from Goldmann applanation tonometry when available (45%), and otherwise from Icare, Tono-pen, noncontact tonometry, and pneumotonometry. Among 16,169 matched pairs, average IOP after the index date was lower in the surgical than non-surgical group throughout follow-up to 36 months. The difference was greatest during 1-18 months, during which IOP increased by 0.22 mm Hg from 16.49 mm Hg in the average non-surgical patient and decreased by 0.99 mm Hg from 16.50 mm Hg in the average surgical patient (difference-in-difference, 1.21 with 95% CI 1.12-1.30 mm Hg). The difference-in-difference was greatest for patients with ocular hypertension (2.00 mm Hg) and for patients with preoperative IOP ≥20 (2.46 mm Hg). A subgroup analysis with matched patients using only Goldmann applanation tonometry found similar results. By 30-36 months, 5% (95% CI 4-6%) fewer surgical patients used an ophthalmic medication. In the surgical group the odds of selective laser trabeculoplasty was reduced in patients with ocular hypertension (odds ratio [OR], 0.27; 95% CI 0.10-0.74) or glaucoma suspect (OR, 0.31; 95% CI 0.20-0.47), while the odds of glaucoma surgery were elevated in surgical patients with primary open angle glaucoma (OR, 1.48; 95% CI 1.08-2.01). In this community-based study, the association of phacoemulsification for cataract with IOP reduction was lower than in past referral-based studies. Surgeons should expect to reduce intraocular pressure approximately 1-2 mmHg with phacoemulsification in patients with preoperative IOP less than 20 mmHg. In this community-based study of glaucoma patients and glaucoma suspects with mid-normal IOP, the association of phacoemulsification for cataract with IOP reduction was lower than reported in past referral-based studies. Surgeons should expect to reduce intraocular pressure approximately 1-2 mmHg with phacoemulsification.
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DOI：
10.1001/jama.2014.3192
发表时间：
2014-05-14
期刊：
JAMA
影响因子：
--
作者：
Weinreb RN;Aung T;Medeiros FA
通讯作者：
Medeiros FA
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
2
作者：
Bojikian, Karine D.;Chen, Philip P.
通讯作者：
Chen, Philip P.
影响因子：
13.7
作者：
Samuelson, Thomas W.;Chang, David F.;Singh, Kuldev
通讯作者：
Singh, Kuldev
影响因子：
2
作者：
Vinod, Kateki;Gedde, Steven J.;Parrish, Richard K., II
通讯作者：
Parrish, Richard K., II