背景:PRESERFLO™MicroShunt(PMS)已被证明可以显着降低青光眼患者的眼内压(IOP),并且自2019年以来一直可以使用。随着越来越多的公开证据和青光眼外科医生的经验,这个改良的Delphi小组的目的是在2021年之前进行的Delphi小组的研究结果的基础上,为PMS在欧洲治疗青光眼患者中的作用提供进一步的指导.
方法:13名在PMS手术中有经验的欧洲青光眼外科医生参加了3轮改良的Delphi小组。有针对性的文献审查和专家指导委员会指导了第一轮问卷的开发。共识的预定阈值为≥70%的小组成员选择“强烈同意”/“同意”或“强烈不同意”/“不同意”或“不同意”的6点李克特量表问题或≥70%选择多个或单选题的相同选项。未达成共识的问题已在下一轮中重述/修订,遵循自由文本回答/范围界定问题的指导。
结果:总计,28%(n=9/32),52%(n=16/31)和91%(n=10/11)的陈述分别在第1、2和3轮中达成共识。人们一致认为PMS可以用于色素性患者,创伤后或玻璃体切除术后青光眼和无活动性炎症的葡萄膜青光眼患者。与其他结膜下滤过手术相比,PMS可能更适合隐形眼镜患者,没有消除与水泡相关的风险。达成共识,PMS植入和白内障超声乳化术的结合可能与独立PMS手术一样安全。但需要进一步的疗效数据.术后IOP升高≥4个月后,局部水性抑制剂滴剂或气泡修正可能是合适的管理选择。
结论:本Delphi小组建立在2021年Delphi小组中探讨的考虑因素的基础上,并为青光眼外科医生提供了使用PMS的进一步详细指导。反映了新证据和手术经验的可用性。视频可用于本文。
BACKGROUND: The PRESERFLO™ MicroShunt (PMS) has been proven to significantly lower intraocular pressure (IOP) in patients with glaucoma and has been available for use since 2019. With increasing published evidence and growing experience of glaucoma surgeons, the aim of this modified Delphi panel was to build on the findings of a previous Delphi panel conducted in 2021 and provide further guidance on the role of the PMS to treat patients with glaucoma in Europe.
METHODS: Thirteen European glaucoma surgeons experienced in the PMS procedure participated in a 3-round modified Delphi panel. A targeted literature review and expert steering committee guided Round 1 questionnaire development.
Consensus was pre-defined at a threshold of ≥ 70% of panellists selecting \'strongly agree\'/\'agree\' or \'strongly disagree\'/\'disagree\' for 6-point Likert scale questions or ≥ 70% selecting the same option for multiple or single-choice questions. Questions not reaching
consensus were restated/revised for the next round, following guidance from free-text responses/scoping questions.
RESULTS: In total, 28% (n = 9/32), 52% (n = 16/31) and 91% (n = 10/11) of statements reached
consensus in Rounds 1, 2 and 3, respectively. There was agreement that the PMS may be used in patients with pigmentary, post-trauma or post-vitrectomy glaucoma and for patients with uveitic glaucoma without active inflammation. The PMS may be more suitable for patients with contact lenses than other subconjunctival filtering surgeries, without eliminating bleb-associated risks.
Consensus was reached that combining PMS implantation and phacoemulsification may be as safe as standalone PMS surgery, but further efficacy data are required. Following a late rise in IOP ≥ 4 months post-surgery, topical aqueous suppressant drops or bleb revision may be suitable management options.
CONCLUSIONS: This Delphi panel builds on the considerations explored in the 2021 Delphi panel and provides further detailed guidance for glaucoma surgeons on the use of the PMS, reflecting the availability of novel evidence and surgical experience. Videos are available for this article.