Practice Preferences for Glaucoma Surgery: A Survey of the American Glaucoma Society
Practice Preferences for Glaucoma Surgery: A Survey of the American Glaucoma Society
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DOI：
10.1097/ijg.0000000000000720
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发表时间：
2017-08-01
影响因子：
2
通讯作者：
Parrish, Richard K., II
中科院分区：
文献类型：
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作者：
Vinod, Kateki;Gedde, Steven J.;Parrish, Richard K., II
目的：本研究的目的是评估美国青光眼协会（AGS）会员的手术实践模式。方法：一份评估青光眼手术在不同临床环境下使用情况的匿名在线调查被重新分发给AGS成员。对1996年、2002年和2008年的调查结果进行比较，以确定外科手术模式的转变。增加问题以评估原发性切口青光眼手术和超声乳化联合青光眼手术的首选方法。结果：在1091名AGS-net用户中，共有252人（23%）参与了调查。在原发性开角型青光眼患者中，小梁切除术联合丝裂霉素C （MMC）、青光眼引流装置（GDD）和微创青光眼手术（MIGS）作为初始手术的比例（meanSD）分别为59%+/- 30%、23%+/- 23%和14%+/- 20%。在44%+/- 32%的原发性开角型青光眼和显著性白内障患者中，单纯超声乳化白内障摘除是首选手术入路，超声乳化白内障摘除联合小梁切除术联合MMC的比例为24%+/- 23%，MIGS为22%+/- 27%，GDD为9%+/- 14%。尽管1996年8个临床环境中有8个选择小梁切除术作为青光眼手术治疗的首选，但2016年8个临床环境中有7个选择GDD。结论：在过去的20年里，GDD的使用增加了，小梁切除术的使用同时减少了。小梁切除术与MMC是最流行的原发性切口手术，无论是单独进行还是联合超声乳化白内障摘除。外科医生经常单独用白内障摘除来治疗并发的白内障和青光眼，而不是联合白内障和青光眼手术。
Purpose:The purpose of this study is to assess surgical practice patterns among the American Glaucoma Society (AGS) membership.Methods:An anonymous online survey evaluating the use of glaucoma surgeries in various clinical settings was redistributed to AGS members. Survey responses were compared with prior results from 1996, 2002, and 2008 to determine shifts in surgical practice patterns. Questions were added to assess the preferred approach to primary incisional glaucoma surgery and phacoemulsification combined with glaucoma surgery.Results:A total of 252 of 1091 (23%) subscribers to the AGS-net participated in the survey. Percentage use (meanSD) of trabeculectomy with mitomycin C (MMC), glaucoma drainage device (GDD), and minimally invasive glaucoma surgery (MIGS) as an initial surgery in patients with primary open angle glaucoma was 59%+/- 30%, 23%+/- 23%, and 14%+/- 20%, respectively. Phacoemulsification cataract extraction alone was the preferred surgical approach in 44%+/- 32% of patients with primary open angle glaucoma and visually significant cataract, and phacoemulsification cataract extraction was combined with trabeculectomy with MMC in 24%+/- 23%, with MIGS in 22%+/- 27%, and with GDD in 9%+/- 14%. Although trabeculectomy was selected most frequently to surgically manage glaucoma in 8 of 8 clinical settings in 1996, GDD was preferred in 7 of 8 clinical settings in 2016.Conclusions:The use of GDD has increased and that of trabeculectomy has concurrently decreased over the past 2 decades. Trabeculectomy with MMC is the most popular primary incisional surgery when performed alone or in combination with phacoemulsification cataract extraction. Surgeons frequently manage coexistent cataract and glaucoma with cataract extraction alone, rather than as a combined cataract and glaucoma procedure.