Can early postoperative intraocular pressure predict success following mitomycin-C augmented trabeculectomy in primary angle-closure glaucoma
Can early postoperative intraocular pressure predict success following mitomycin-C augmented trabeculectomy in primary angle-closure glaucoma
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DOI：
10.1038/eye.2012.291
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发表时间：
2013-03
期刊：
影响因子：
3.9
通讯作者：
S. Rong;S. Rong;M. Feng;Ningli Wang;H. Meng;Ravi Thomas;S. Fan;R. Wang;X. Wang;X. Tang;Yuanbo Liang;Yuanbo Liang
中科院分区：
文献类型：
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作者：
S. Rong;S. Rong;M. Feng;Ningli Wang;H. Meng;Ravi Thomas;S. Fan;R. Wang;X. Wang;X. Tang;Yuanbo Liang;Yuanbo Liang
目的评估术后早期和晚期眼压（IOP）之间的相关性，并确定术后早期眼压是否可以预测手术结果。方法连续 165 例接受原发性丝裂霉素 C 增强小梁切除术的原发性闭角型青光眼（PACG）患者在手术前接受了全面的眼部检查，并在第 1、7、14、30 天以及第 3、6、12 和 3 个月进行随访。 18. 第 1、7、14 和 30 天的眼压分为 A 组（< 10 mm Hg）、B 组（≥ 10 且< 15 mm Hg）、C 组（≥ 15 且< 20 mm Hg）和 D 组（≥ 20 mm Hg）。使用方差分析（ANOVA）和费舍尔精确检验分析组间差异。采用多变量回归检验早期眼压对最终结果的预测能力。结果平均年龄为62.5±7.9岁，其中41.21%（n=68）为男性。分别按第 1、7、14 和 30 天的 IOP 分层，A、B、C 和 D 组在第 18 个月时的平均 IOP 不同（方差分析，分别为 P= 0.047、P= 0.033、P= 0.008 和 P< 0.001）。一旦通过第 7 天的干预措施解决了眼压问题，在不同结果定义下，较高的眼压水平与成功率降低相关，最终眼压< 15 mm Hg（Fisher 精确 P= 0.001）和 < 20 mm Hg（P= 0.039），无需药物治疗。多元回归显示早期眼压可独立于基线变量预测最终眼压。第 7 天 13.5 mm Hg 的临界值在预测 IOP < 15 mm Hg（不用药）和术后失败的情况下的准确度分别为 80.0 和 57.1%。结论 PACG 患者初次抗纤维化增强小梁切除术后 18 个月的 IOP 与术后 1 个月的 IOP 相关，并由术后 1 个月的 IOP 进行预测。早期将眼压控制在 13.5 或更低可能会带来更好的结果。
PurposeTo evaluate the association between early and late postoperative intraocular pressure (IOP) and determine if early postoperative IOP can predict the surgical outcome.MethodsA total of 165 consecutive patients with primary angle-closure glaucoma (PACG) undergoing primary mitomycin-C-augmented trabeculectomy underwent a comprehensive eye examination before surgery and were followed-up on days 1, 7, 14, and 30, and months 3, 6, 12, and 18. IOPs on days 1, 7, 14, and 30 were stratified into groups A (< 10 mm Hg), B (≥ 10 and< 15 mm Hg), C (≥ 15 and< 20 mm Hg), and D (≥ 20 mm Hg). Differences between groups were analyzed using analysis of variance (ANOVA) and Fisher’s exact test. Multivariable regression was used to exam the predictive ability of early IOP for final outcome.ResultsThe mean age was 62.5±7.9 years and 41.21%(n= 68) were males. Stratified by IOP on days 1, 7, 14, and 30, respectively, mean IOPs at month 18 were different among groups A, B, C, and D (ANOVA, P= 0.047, P= 0.033, P= 0.008, and P< 0.001, respectively). Once the IOPs were settled with interventions on day 7 a higher IOP level was associated with decreasing success rate under different outcome definitions, final IOP< 15 mm Hg (Fisher’s exact P= 0.001) and< 20 mm Hg (P= 0.039) without medication. Multiple regression showed early IOP predicted final IOP independently from baseline variables. A cutoff value of 13.5 mm Hg on day 7 achieved an accuracy of 80.0 and 57.1% in predicting IOP< 15 mm Hg without medication and failure after surgery, respectively.ConclusionsThe IOP at 18 months following primary antifibrotic-augmented trabeculectomy in PACG patients is associated with and predicted by the postoperative IOPs at 1 month. Control of early IOP to 13.5 or less may provide better outcomes.