■尽管持有承诺,在严重青光眼中使用MIGS的报道很少,并且没有描述在该人群中合并多个MIGS。据我们所知,这是报道严重青光眼患者超声乳化术和MIGS(Phaco/MIGS)结局的最大研究.
这项回顾性研究包括327例严重青光眼患者的临床就诊,这些患者接受了Phaco/MIGS和iStent,内圈破坏,KahookDualBlade,Hydrus微支架,或这些MIGS(cMIGS)的组合在2016年至2021年之间进行。主要结果包括通过广义估计方程评估的眼内压(IOP)和药物负担,以及卡普兰-迈耶估计。进一步分析比较了cMIGS和单一Phaco/MIGS(sMIGS)的疗效,程序持续时间,视敏度,和并发症。
■术前平均IOP为16.7mmHg±5.8(SD),总体使用2.3±1.9药物(N=71),sMIGS组的1.7±1.9药物为16.9±6.3mmHg(N=37),cMIGS组的2.9±1.6药物治疗为16.4±5.3mmHg(N=34)。在整个12个月中,Phaco/MIGS导致IOP(p<0.001)和药物(p=0.03)的显着降低模式。12个月时,47.5%,87.5%,64.7%的患者达到IOP≤12mmHg,17mmHg,或预定的目标IOP,分别,没有额外的药物或程序。1.8±1.7药物的平均12个月IOP为13.5±3.1mmHg。在调整基线药物负担后,cMIGS和sMIGS的眼压降低模式(p<0.05)不同,赞成cMIGS,两组患者的用药减少模式相似(p=0.75).
在白内障和严重青光眼患者中使用Phaco/MIGS可以显着降低整个12个月的IOP和药物负担,因此,在进行更具侵入性的青光眼手术之前,可以作为患有视觉上明显的白内障的严重青光眼患者的垫脚石。cMIGS的组合效应可以增强这种效应。
许多接受白内障手术的白内障和轻度或中度青光眼患者也受益于同时进行的微创青光眼手术(MIGS),但是MIGS在严重青光眼和白内障患者中的作用尚不清楚。我们报告说,合并白内障手术和MIGS与严重青光眼患者超过12个月的眼压显着降低有关。
UNASSIGNED: Despite holding promise, reports of using MIGS in severe glaucoma are scarce, and none has described combining multiple MIGS in this population. To the best of our knowledge, this is the largest study to report outcomes of phacoemulsification and MIGS (Phaco/MIGS) in patients with severe glaucoma.
UNASSIGNED: This retrospective review comprised 327 clinical visits of 71 patients with severe glaucoma who underwent Phaco/MIGS with iStent, endocyclodestruction, Kahook Dual Blade, Hydrus Microstent, or a combination of these MIGS (cMIGS) performed between 2016 and 2021. Primary outcomes included intraocular pressure (IOP) and medication burden evaluated by Generalized Estimating Equations, as well as Kaplan-Meier Estimates. Further analyses compared the efficacy of cMIGS and single Phaco/MIGS (sMIGS), procedure duration, visual acuity, and complications.
UNASSIGNED: Mean preoperative IOP was 16.7 mmHg ± 5.8 (SD) on 2.3 ± 1.9 medications overall (N = 71), 16.9 ± 6.3 mmHg on 1.7 ± 1.9 medications in the sMIGS group (N = 37), and 16.4 ± 5.3 mmHg on 2.9 ± 1.6 medications in the cMIGS group (N = 34). Throughout 12 months, Phaco/MIGS led to significant reduction patterns in IOP (p < 0.001) and medications (p = 0.03). At 12 months, 47.5%, 87.5%, and 64.7% of the patients achieved IOP ≤ 12 mmHg, 17 mmHg, or predetermined goal IOP, respectively, without additional medication or procedure. Mean 12-month IOP was 13.5 ± 3.1 mmHg on 1.8 ± 1.7 medications. After adjusting for baseline medication burden, the reduction pattern in IOP (p < 0.05) was different between cMIGS and sMIGS, favoring cMIGS, and the groups had similar reduction patterns in medications (p = 0.75).
UNASSIGNED: The use of Phaco/MIGS in patients with cataract and severe glaucoma may significantly reduce IOP and medication burden throughout 12 months and, thus, may serve as a stepping stone in severe glaucoma patients with visually significant cataract before proceeding with more invasive glaucoma surgery. This effect may be potentiated by the combination effect of cMIGS.
Many patients with cataract and mild or moderate glaucoma who undergo cataract surgery also benefit from microinvasive glaucoma surgery (MIGS) performed at the same time, but the role of MIGS in patients with severe glaucoma and cataract is not clear. We report that combined cataract surgery and MIGS were associated with significant reductions in eye pressure in patients with severe glaucoma for more than 12 months.