目的:评估晶状体状态和白内障手术对青光眼引流装置(GDD)疗效的影响。
方法:回顾性队列研究。
方法:216例接受GDD植入术患者的243只眼,术后3年内随访1次。排除标准包括GDD联合其他眼科手术。90-94%的GDD是Ahmed植入物;83-90%具有辅助丝裂霉素C。
方法:比较有晶状体眼(A组),眼睛在植入时出现了症状,但随后在三年内接受了白内障手术(B组),和假晶状体眼(C组)。在分流管植入后1、3、6、12、24和36个月测量结果。进行了多元回归模型,调整基线特征。
方法:GDD植入后眼压(IOP)。次要结果包括视力(VA)的变化,青光眼滴眼液的数量,和故障率,定义为额外的青光眼手术,视力下降到无光感知,或IOP持续≤5mmHg或>21mmHg或未从基线降低20%。
结果:A组65只眼,B组52人,126在C组中。在B组中,GDD植入后平均1.3±0.7年进行白内障手术。在术后三年的所有时间点,三组之间的平均IOP或药物治疗没有统计学上的显着差异。与C组相比,A组和B组在六个月时VA显着改善,一年,植入后两年;然而,到术后第三年,各组VA的变化相似.各组之间的失败率没有显着差异(p=0.68)。白内障手术后12个月的IOP和药物治疗与术前基线相似。B组术后短期(p=0.02)和长期(p<0.001)并发症明显多于A或C组,主要是由低潮驱动的。
结论:眼压没有差异,青光眼药物,或根据晶状体状态或接受后续白内障手术后GDD植入后三年的失败率。这些结果可以为患有青光眼和白内障的患者的管理提供信息。
OBJECTIVE: To assess the effect of lens status and cataract surgery on glaucoma drainage device (GDD) efficacy.
METHODS: Retrospective cohort study.
METHODS: Two hundred and forty-three eyes of 216 patients that underwent GDD implantation with ≥1 follow-up visit within 3 years postoperatively. Exclusion criteria included GDD combined with other ophthalmic procedures. 90%-94% of GDDs were Ahmed implants; 83%-90% had adjunctive mitomycin-C.
METHODS: Outcomes were compared between phakic eyes (group A), eyes phakic at time of implantation but subsequently underwent cataract surgery within 3 years (group B), and pseudophakic eyes (group C). Outcomes were measured at 1, 3, 6, 12, 24, and 36 months after tube shunt implantation. Multivariable regression models were performed, adjusting for baseline characteristics.
METHODS: Intraocular pressure (IOP) after GDD implantation. Secondary outcomes included change in visual acuity (VA), number of glaucoma eye drops, and rate of failure, defined as additional glaucoma surgery, vision decrease to no light perception, or IOP persistently ≤ 5 mmHg or > 21 mmHg or not reduced from baseline by 20%.
RESULTS: There were 65 eyes in group A, 52 in group B, and 126 in group C. Within group B, cataract surgery was performed at a mean of 1.3 ± 0.7 years after GDD implantation. There were no statistically significant differences in mean IOP or medications between the 3 groups at all time points up to 3 years postoperatively. Significant improvement in VA was noted in groups A and B compared to group C at 6 months, 1 year, and 2 years after implantation; however, by postoperative year 3, change in VA was similar across groups. There were no significant differences in the failure rate amongst groups (P = 0.68). IOP and medications up to 12 months after cataract surgery were similar compared to preoperative baseline. Group B had significantly more short-term (P = 0.02) and long-term (P < 0.001) postoperative complications than groups A or C, driven primarily by hypotony.
CONCLUSIONS: There were no differences in IOP, glaucoma medications, or rate of failure 3 years after GDD implantation based on lens status or after undergoing subsequent cataract surgery. These results may inform the management of patients with co-existing glaucoma and cataract.
BACKGROUND: The author(s) have no proprietary or commercial interest in any materials discussed in this article.