葡萄膜性青光眼阀管分流术后早期水抑制的效果

IF 2.8 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma Pub Date : 2024-01-01 DOI:10.1016/j.ogla.2023.08.002

Minjia Tang BA , Nathan P. Gill PhD , Angelo P. Tanna MD

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引用次数: 0

摘要

目的比较葡萄膜炎性青光眼植入艾哈迈德青光眼瓣膜（AGV）后早期水抑制（EAS）和标准疗法（ST）的疗效。方法排除术后第1天（POD1），仅将首次就诊时眼压为10-15 mmHg且眼压≥10 mmHg的患者纳入主要分析。早期眼压抑制（EAS）是指眼压首次达到 10-15 mmHg 时开始降眼压治疗。标准疗法是在任何时间开始治疗。治疗失败的定义是：连续 2 次检查，3 个月后眼压比基线降低 21 mmHg、5 mmHg 或 20%。低血压期的定义是连续 2 次就诊时眼压≤ 5 mmHg。结果EAS组26名患者中有28只眼睛，ST组19名患者中有20只眼睛，平均随访时间分别为17.7个月和28.2个月。EAS 组（31.2 ± 10.1 mmHg）和 ST 组（34.6 ± 12.2 mmHg）的基线眼压相似；P = 0.18。EAS 组的最终眼压（12.9 ± 4.6 mmHg）低于 ST 组（16.4 ± 5.7 mmHg；P = 0.02），EAS 组用药 2.6 ± 0.9 次，ST 组用药 1.8 ± 1.5 次（P = 0.07）。87%的 EAS 眼睛和 74% 的 ST 眼睛获得了总体成功（P = 0.43）。在发生额外青光眼手术（EAS 组为 4%，ST 组为 20%；P = 0.11）、眼压过低（EAS 组为 7%，ST 组为 0%；P = 0.50）或高血压期（EAS 组为 4%，ST 组为 21%；P = 0.09）方面，差异无统计学意义。在总体成功率或不良事件发生率方面未观察到有统计学意义的差异。

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Effect of Early Aqueous Suppression After Valved Tube Shunt Surgery for Uveitic Glaucoma

Purpose

To compare outcomes of early aqueous suppression (EAS) and standard therapy (ST) after Ahmed Glaucoma Valve (AGV) implantation for uveitic glaucoma.

Design

Retrospective comparative cohort study.

Participants

All patients with uveitic glaucoma underwent AGV implantation from January 2010 to October 2020 at Northwestern Medicine.

Methods

Excluding the first postoperative day 1 (POD1), only eyes with IOP 10–15 mmHg at their first visit with IOP ≥ 10 mmHg were included in the main analysis. Early aqueous suppression (EAS) was defined as initiation of ocular hypotensive therapy when IOP was first 10–15 mmHg. Standard therapy was initiation of therapy at any later time. Failure was defined as IOP > 21 mmHg, < 5 mmHg, or < 20% reduction in IOP from baseline after 3 months, for 2 consecutive study visits. Hypotony was defined as IOP ≤ 5 mmHg for ≥ 2 visits. Hypertensive phase was defined as IOP > 21 mmHg for 2 consecutive visits in the first 3 months.

Main Outcome Measures

Proportion achieving overall success; incidence of hypotony and hypertensive phase.

Results

Twenty-eight eyes of 26 patients were in the EAS group and 20 eyes of 19 patients were in the ST group, with a mean follow-up of 17.7 and 28.2 months, respectively. Baseline IOP was similar in the EAS (31.2 ± 10.1 mmHg) and ST (34.6 ± 12.2 mmHg) groups; P = 0.18. Final IOP was lower in the EAS group (12.9 ± 4.6 mmHg) than the ST group (16.4 ± 5.7 mmHg; P = 0.02) on 2.6 ± 0.9 medications in the EAS group and 1.8 ± 1.5 in the ST group (P = 0.07). Overall success was achieved in 87% of EAS eyes and 74% of ST eyes (P = 0.43). There were no statistically significant differences in the occurrence of additional glaucoma surgery (4% for EAS, 20% for ST; P = 0.11), hypotony (7% for EAS, 0% for ST; P = 0.50), or hypertensive phase (4% for EAS, 21% for ST; P = 0.09).

Conclusions

EAS was associated with a lower final IOP after AGV in uveitic glaucoma eyes; however, more medications were in use at the final visit. No statistically significant differences in overall success or the incidence of adverse events were observed.