Efficacy of Filtration Surgery and Risk Factors for Central Visual Field Deterioration in Highly Myopic Eyes with Open-Angle Glaucoma.

IF 2 4区 医学 Q2 OPHTHALMOLOGY
Takeshi Yoshida, Nan Zhou, Sota Yoshimoto, Keigo Sugisawa, Motohisa Ohno, Shintaro Yasuda, Yuto Shiotani, Ryu Teramatsu, Kyoko Ohno-Matsui
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Abstract

Prcis: This study demonstrates the effectiveness of filtration surgery in preserving the central visual field in eyes showing open-angle glaucoma with high myopia, highlighting the necessity of intraocular pressure reduction ≥30% for optimal outcomes.

Purpose: To evaluate the efficacy of filtration surgery in preserving the central visual field (VF) in eyes with open-angle glaucoma (OAG) and high myopia (HM) and identify postoperative intraocular pressure (IOP) targets and factors associated with targeted IOP reduction.

Methods: This retrospective cohort study included 55 eyes (48 patients) with OAG and HM who underwent filtration surgery and were followed up for minimum 3 years. Pre- and postoperative IOP values, mean deviation (MD) values, and MD slopes from Humphrey 10-2 VF tests were assessed. Participants were categorized according to the postoperative MD slope (>-0.5 dB/year or ≤-0.5 dB/year) to evaluate surgical success, defined as IOP reduction of ≥20%, ≥30%, or ≥40% from baseline. Predictors of targeted IOP reduction were identified.

Results: Significant postoperative IOP reductions were observed at all time points ( P <0.001). The mean MD slope improved from -1.53±0.91 to -1.00±1.40 dB/year ( P =0.001). Eyes with MD slope ≤-0.5 dB/year had a longer axial length (AL; P =0.048), more needling procedures ( P =0.003), and higher postoperative IOP at 1 and 2 years ( P <0.001, P =0.021, respectively). Surgical success rates (IOP reduction ≥30% and ≥40%) were higher for eyes with MD slope >-0.5 dB/year ( P =0.006, P =0.003), with no significant difference for IOP reduction ≥20% ( P =0.087). To achieve postoperative MD slope >-0.5 dB/year, minimum 30% IOP reduction was required. If AL was >28.01 mm, 40% IOP reduction was required. AL and needling procedure frequency were significantly associated with IOP reduction ≥30% (odds ratio=1.79 and 2.26; P =0.018 and 0.039, respectively).

Conclusions: Substantial IOP reduction is essential for preserving the central visual field in eyes with OAG and HM, particularly those with AL ≥28.01 mm. Longer AL and frequent needling procedures increase the surgical failure risk.

滤过手术治疗高度近视伴开角型青光眼中央视野恶化的疗效及危险因素分析。
实践:本研究证明了滤过手术在保护高度近视开角型青光眼中心视野方面的有效性,强调了眼压降低≥30%的必要性,以获得最佳效果。目的:评价滤过手术对开角型青光眼(OAG)和高度近视(HM)患者中心视野(VF)的保护效果,确定术后眼压(IOP)降低靶点及相关因素。方法:回顾性队列研究包括55眼(48例)接受滤过手术的OAG和HM患者,随访至少3年。评估Humphrey 10-2 VF试验的术前和术后IOP值、平均偏差(MD)值和MD斜率。参与者根据术后眼压斜率(>-0.5 dB/年或≤-0.5 dB/年)进行分类,以评估手术成功,定义为IOP较基线降低≥20%,≥30%或≥40%。确定了目标IOP降低的预测因素。结果:术后各时间点IOP均显著降低(P= 0.5 dB/年,P=0.006, P=0.003), IOP降低≥20%无显著性差异(P=0.087)。为了达到术后MD斜率>-0.5 dB/年,至少需要30%的IOP降低。如果AL≥28.01 mm,则需要降低40% IOP。AL和针刺手术频率与IOP降低≥30%显著相关(优势比分别为1.79和2.26;P分别=0.018和0.039)。结论:对于OAG和HM患者,特别是AL≥28.01 mm的患者,大幅度降低IOP对于保持中心视野至关重要。较长的AL和频繁的针刺操作增加了手术失败的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Glaucoma
Journal of Glaucoma 医学-眼科学
CiteScore
4.20
自引率
10.00%
发文量
330
审稿时长
4-8 weeks
期刊介绍: The Journal of Glaucoma is a peer reviewed journal addressing the spectrum of issues affecting definition, diagnosis, and management of glaucoma and providing a forum for lively and stimulating discussion of clinical, scientific, and socioeconomic factors affecting care of glaucoma patients.
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