PDF(Pubmed)
Abstract：
BACKGROUND: Neovascular glaucoma (NVG) is a secondary glaucoma with a poor visual prognosis. Trabeculectomy with antifibrotic agents, glaucoma drainage devices (GDDs), and cyclo-destructive procedures are recommended in patients who are refractory to medical management. However, due to the poor success rate of conventional trabeculectomy and the higher cost of GDDs, alternative procedures need to be looked at.
OBJECTIVE: To compare the surgical outcomes and economic aspects of a newly developed polypropylene suture bed-based modified trabeculectomy to Ahmed glaucoma valve (AGV) implantation for NVG.
METHODS: It was a prospective interventional study conducted at a tertiary care center between 2018 and 2020. Consecutive patients with NVG with a minimum follow-up of 18 months were included. Surgical outcomes are mainly based on intraocular pressure (IOP) control and the cost of surgery.
RESULTS: Sixty eyes were included out of which 40 (60.6%) underwent modified trabeculectomy and 20 (33.7%) underwent AGV. At the final follow-up, no significant difference (P < 0.05) was found between the surgical outcomes of both groups. The complete success rate (IOP < 21 mm Hg without antiglaucoma medications) was 60 and 65% while the qualified success rate (IOP < 21 mm Hg with antiglaucoma medications) was 30 and 25% in modified trabeculectomy and AGV groups, respectively, at final follow-up. The cost of surgery was significantly higher in the AGV group (P < 0.0001).
CONCLUSIONS: Modified trabeculectomy as described might be a better alternative for NVG eyes.
OBJECTIVE: To compare the surgical outcomes and economic aspects of a newly developed polypropylene suture bed-based modified trabeculectomy to Ahmed glaucoma valve (AGV) implantation for NVG.
METHODS: It was a prospective interventional study conducted at a tertiary care center between 2018 and 2020. Consecutive patients with NVG with a minimum follow-up of 18 months were included. Surgical outcomes are mainly based on intraocular pressure (IOP) control and the cost of surgery.
RESULTS: Sixty eyes were included out of which 40 (60.6%) underwent modified trabeculectomy and 20 (33.7%) underwent AGV. At the final follow-up, no significant difference (P < 0.05) was found between the surgical outcomes of both groups. The complete success rate (IOP < 21 mm Hg without antiglaucoma medications) was 60 and 65% while the qualified success rate (IOP < 21 mm Hg with antiglaucoma medications) was 30 and 25% in modified trabeculectomy and AGV groups, respectively, at final follow-up. The cost of surgery was significantly higher in the AGV group (P < 0.0001).
CONCLUSIONS: Modified trabeculectomy as described might be a better alternative for NVG eyes.
摘要：
背景：新生血管性青光眼（NVG）是继发性青光眼，视力预后较差。使用抗纤维化药物的小梁切除术，青光眼引流装置（GDD），对于难以接受医疗管理的患者，建议使用循环破坏程序。然而,由于传统小梁切除术的成功率较低，GDD的成本较高，需要考虑替代程序。
目的：比较新开发的基于聚丙烯缝合床的改良小梁切除术与Ahmed青光眼阀（AGV）植入NVG的手术效果和经济方面。
方法：这是一项前瞻性干预研究，于2018年至2020年在三级护理中心进行。纳入了至少18个月随访的连续NVG患者。手术结果主要取决于眼内压（IOP）控制和手术费用。
结果：共60只眼，其中40只眼（60.6%）行改良小梁切除术，20只眼（33.7%）行AGV。在最后的后续行动中，两组患者的手术结局差异无统计学意义（P<0.05）。改良小梁切除术和AGV组的完全成功率（眼压<21mmHg，不使用抗青光眼药物）分别为60％和65％，而合格成功率（使用抗青光眼药物的眼压<21mmHg）分别为30％和25％。分别,在最后的后续行动。AGV组的手术费用明显较高(P<0.0001)。
结论：所描述的改良小梁切除术可能是NVG眼的更好选择。
目的：比较新开发的基于聚丙烯缝合床的改良小梁切除术与Ahmed青光眼阀（AGV）植入NVG的手术效果和经济方面。
方法：这是一项前瞻性干预研究，于2018年至2020年在三级护理中心进行。纳入了至少18个月随访的连续NVG患者。手术结果主要取决于眼内压（IOP）控制和手术费用。
结果：共60只眼，其中40只眼（60.6%）行改良小梁切除术，20只眼（33.7%）行AGV。在最后的后续行动中，两组患者的手术结局差异无统计学意义（P<0.05）。改良小梁切除术和AGV组的完全成功率（眼压<21mmHg，不使用抗青光眼药物）分别为60％和65％，而合格成功率（使用抗青光眼药物的眼压<21mmHg）分别为30％和25％。分别,在最后的后续行动。AGV组的手术费用明显较高(P<0.0001)。
结论：所描述的改良小梁切除术可能是NVG眼的更好选择。
