Comparing Surgical Outcomes in Neovascular Glaucoma between Tube and Trabeculectomy A Multicenter Study
Comparing Surgical Outcomes in Neovascular Glaucoma between Tube and Trabeculectomy A Multicenter Study
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DOI：
10.1016/j.ogla.2022.05.003
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发表时间：
2022-11-21
影响因子：
2.9
通讯作者：
Inatani, Masaru
中科院分区：
文献类型：
--
作者：
Iwasaki, Kentaro;Kojima, Sachi;Inatani, Masaru
目的：比较 Baerveldt 青光眼植入术 (BGI) 手术与丝裂霉素 C 小梁切除术治疗新生血管性青光眼 (NVG) 患者的手术结果。设计：在日本 5 个临床中心进行的回顾性临床队列研究。参与者：2012 年 4 月 1 日至 2019 年 12 月 31 日期间在 5 个临床中心接受小梁切除术或 BGI 治疗 NVG 的患者方法：纳入标准为年龄>20岁且患有NVG。排除标准是没有光感视力且之前接受过管分流手术的眼睛。如果同一患者的两只眼睛都满足纳入标准，则对首先接受治疗的眼睛进行研究。我们纳入了 100 只接受 BGI 手术的眼睛和 204 只接受小梁切除术的眼睛。 主要结果指标：主要结果是手术成功或失败，失败根据 3 个标准定义：术前眼压 (IOP) 降低 < 20% 或标准 A (IOP > 21 mmHg)、标准 B (IOP > 17 mmHg) 或标准 C (IOP > 14 mmHg)。再次手术、光感视力丧失或眼压过低的情况也被视为失败。 结果：根据标准 A（P < 0.01）和 B（P = 0.01），接受 BGI 手术的患者成功概率显着高于接受小梁切除术的患者。在标准 A（风险比，1.70）和标准 B（风险比，1.50）的多变量分析中，小梁切除术与手术失败显着相关。两组术后并发症的总体发生率相似。小梁切除术组因青光眼再次手术的频率显着高于 BGI 手术组（20.1% vs. 5.0%；P < 0.01）。结论：对于目标 IOP < 21 mmHg 或 < 17 mmHg 的 NVG 患者，Baerveldt 青光眼植入手术比小梁切除术具有更高的成功率。两种手术的术后并发症发生率相似。小梁切除术后比华大基因手术后更频繁地需要进行额外的青光眼手术。眼科青光眼 2022;5:672-680 (c) 2022 由 Elsevier Inc. 代表美国眼科学会出版
Objective: To compare the surgical outcomes between Baerveldt glaucoma implant (BGI) surgery and trabeculectomy with mitomycin C for patients with neovascular glaucoma (NVG).Design: Retrospective clinical cohort study at 5 clinical centers in Japan.Participants: Patients treated with trabeculectomy or BGI for NVG between April 1, 2012, and December 31, 2019, at 5 clinical centers were recruited.Methods: The inclusion criteria were age > 20 years and having NVG. The exclusion criteria were eyes with no light perception vision and with previous tube-shunt surgery. If both eyes in the same patient satisfied the inclusion criteria, the eye that was treated first was investigated. We included 100 eyes undergoing BGI surgery and 204 eyes undergoing trabeculectomy.Main Outcome Measures: The primary outcome was surgical success or failure, with failure being defined according to 3 criteria: < 20% reduction of the preoperative intraocular pressure (IOP) or criterion A (IOP > 21 mmHg), criterion B (IOP > 17 mmHg), or criterion C (IOP > 14 mmHg). Cases of reoperation, a loss of light perception vision, or hypotony were also considered failures.Results: The probability of success was significantly higher in patients undergoing BGI surgery than in those receiving trabeculectomy for criteria A (P < 0.01) and B (P = 0.01). Trabeculectomy was significantly associated with surgical failure in the multivariable analysis for criterion A (hazard ratio, 1.70) and criterion B (hazard ratio, 1.50). The overall incidence of postoperative complications was similar between the 2 groups. Reoperations for glaucoma were required significantly more frequently in the trabeculectomy group than in the BGI surgery group (20.1 % vs. 5.0%; P < 0.01).Conclusions: Baerveldt glaucoma implant surgery had a higher success rate compared with trabeculectomy in patients with NVG for a target IOP < 21 mmHg or < 17 mmHg. The rates of postoperative complications were similar between both surgical procedures. Additional glaucoma surgery was required more frequently after trabeculectomy than after BGI surgery. Ophthalmology Glaucoma 2022;5:672-680 (c) 2022 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology