Outcomes of Ahmed glaucoma valve and transscleral cyclophotocoagulation in neovascular glaucoma.
Outcomes of Ahmed glaucoma valve and transscleral cyclophotocoagulation in neovascular glaucoma.
复制标题
DOI：
10.4103/ijo.ijo_2107_21
复制
发表时间：
2022-04
影响因子：
3.1
通讯作者：
Shukla, Aakriti G.
中科院分区：
文献类型：
--
作者：
Shalaby, Wesam S.;Ganjei, Allen Y.;Wogu, Brian;Myers, Jonathan S.;Moster, Marlene R.;Razeghinejad, Reza;Lee, Daniel;Kolomeyer, Natasha N.;Eid, Tarek E.;Katz, L. Jay;Shukla, Aakriti G.
关键词：
探讨Ahmed青光眼阀（AGV）与经巩膜二极管睫状体光凝（CPC）治疗新生血管性青光眼（NVG）的疗效。这是一项单中心回顾性比较病例系列，涉及对接受AGV或CPC治疗NVG且随访时间≥6个月的连续患者进行图表审查。6个月时手术失败，定义为1个月后IOP>21或<6 mm Hg伴低眼压性黄斑病变，进展为无光感（NLP）视力，青光眼再次手术或AGV切除是主要结局指标。共纳入121例患者的121只眼（70只AGV和51只CPC）。两组之间的基线人口统计学、视力（VA）和眼内压（IOP）相当。6个月时，CPC组的失败率显著高于AGV组（43.1% vs. 17.1%，P = 0.020）。两组在6个月时的IOP和用药次数相似，但CPC组的VA显著低于AGV组（2.4 ± 0.8 vs. 1.9 ± 1.0，P = 0.017）。因青光眼需要再次手术的CPC眼多于AGV眼（11.8% vs. 1.4%，P = 0.041）。多变量回归分析确定术前高眼压（P = 0.001）和CPC手术（P = 0.004）是6个月时手术失败的独立预测因素。年龄、性别、种族、NVG病因、基础视网膜病变的双侧性、围手术期视网膜治疗和既往或联合玻璃体切除术均不显著，6个月时，AGV和CPC在NVG眼中的IOP和药物降低相当。CPC更常与失败、青光眼再手术和视力结果较差相关。术前高眼压和CPC手术独立预测手术失败。
To determine the outcomes of Ahmed glaucoma valve (AGV) and transscleral diode cyclophotocoagulation (CPC) in neovascular glaucoma (NVG). This was a single-center retrospective comparative case series involving chart review of consecutive patients who underwent AGV or CPC for treatment of NVG and had ≥6 months of follow-up. Surgical failure at 6 months, defined as an IOP of >21 or <6 mm Hg with hypotony maculopathy after 1 month, progression to no light perception (NLP) vision, glaucoma reoperation, or removal of AGV were the main outcome measures. In total, 121 eyes of 121 patients were included (70 AGV and 51 CPC). Baseline demographics, visual acuity (VA), and intraocular pressure (IOP) were comparable between groups. At 6 months, failure was significantly higher in the CPC group than in the AGV group (43.1% vs. 17.1%, P = 0.020). Both groups had similar IOP and medication number at 6 months, but VA was significantly lower in the CPC group compared to the AGV group (2.4 ± 0.8 vs. 1.9 ± 1.0, P = 0.017). More CPC eyes required reoperation for glaucoma than AGV eyes (11.8% vs. 1.4%, P = 0.041). Multivariate regression analysis identified higher preoperative IOP (P = 0.001) and CPC surgery (P = 0.004) as independent predictors of surgical failure at 6 months. Age, sex, race, NVG etiology, bilaterality of the underlying retinal pathology, perioperative retina treatment, and prior or combined vitrectomy were not significant AGV and CPC had comparable IOP and medication reduction in NVG eyes at 6 months. CPC was more frequently associated with failure, reoperation for glaucoma, and worse visual outcomes. High preoperative IOP and CPC surgery independently predicted surgical failure.