Takeshi Yoshida, Nan Zhou, Sota Yoshimoto, Keigo Sugisawa, Motohisa Ohno, Shintaro Yasuda, Yuto Shiotani, Ryu Teramatsu, Kyoko Ohno-Matsui
{"title":"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。","authors":"Takeshi Yoshida, Nan Zhou, Sota Yoshimoto, Keigo Sugisawa, Motohisa Ohno, Shintaro Yasuda, Yuto Shiotani, Ryu Teramatsu, Kyoko Ohno-Matsui","doi":"10.1097/IJG.0000000000002611","DOIUrl":null,"url":null,"abstract":"<p><strong>Prcis: </strong>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.</p><p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":15938,"journal":{"name":"Journal of Glaucoma","volume":" ","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy of Filtration Surgery and Risk Factors for Central Visual Field Deterioration in Highly Myopic Eyes with Open-Angle Glaucoma.\",\"authors\":\"Takeshi Yoshida, Nan Zhou, Sota Yoshimoto, Keigo Sugisawa, Motohisa Ohno, Shintaro Yasuda, Yuto Shiotani, Ryu Teramatsu, Kyoko Ohno-Matsui\",\"doi\":\"10.1097/IJG.0000000000002611\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Prcis: </strong>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.</p><p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":15938,\"journal\":{\"name\":\"Journal of Glaucoma\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-07-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Glaucoma\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/IJG.0000000000002611\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"OPHTHALMOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Glaucoma","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/IJG.0000000000002611","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
Efficacy of Filtration Surgery and Risk Factors for Central Visual Field Deterioration in Highly Myopic Eyes with Open-Angle Glaucoma.
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.
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.