目的:回顾青光眼手术结果研究中使用的低眼压衰竭标准,并评估其对成功率的影响。
方法:系统文献回顾和低张力衰竭标准在两个回顾性队列中的应用。
方法:934只眼和1,765只眼接受小梁切除术和深层巩膜切除术(DS),中位随访时间为41.4个月和45.4个月。分别。
方法:将基于文献的低张力衰竭标准应用于患者队列。与IOP相关的成功定义为:(A)IOP≤21mmHg,IOP降低≥20%;(B)IOP≤18mmHg,降低≥20%;(C)IOP≤15mmHg,降低≥25%;(D)IOP≤12mmHg,降低≥30%。失败定义为:手术后连续两次就诊>3个月,IOP超过这些标准,失去光的感知,额外的降眼压手术,或者矮胖。Cox回归估计不同低张力标准的故障风险,不使用hypotony作为参考。对每个标准和低张力类型进行了分析(即,数字[IOP阈值],临床[临床表现],混合[数字和/或临床标准的组合])。
方法:失效风险的危险比(HR)。
结果:在2,503项研究中发现,278是合格的,99项(35.6%)研究缺乏低眼压失败标准。数字低渗占主导地位(157项研究[56.5%])。很少有研究采用临床低眼压(3例孤立[1.1%];19例合并低眼压[6.8%])。发现了49个不同的标准,眼压<6mmHg,3个月后连续就诊≥2次,IOP<6mmHg,和IOP<5mmHg是最常见的(41[14.7%],38[13.7%],和13项[4.7%]研究,分别)。在这两个队列中,数字低渗造成最高的失败风险(标准A至D的HR在1.51-1.21之间;p<0.001),其次是混合性低张力(标准A至D的HR在1.41-1.20之间;p<0.001),和临床低眼压(HR在1.12-1.04之间;DS标准D的p=0.07,其他标准p≤0.017)。故障风险随不同的低张力定义而变化很大,小梁切除术的HR在1.02-10.79之间,DS的HR在1.00-8.36之间。
结论:青光眼文献中的低眼压衰竭标准具有高度异质性,很少有研究关注临床表现。与临床低眼压相比,数值低眼压产生的失败率更高,并且可能低估青光眼手术的成功率。需要标准化失败标准,重点是临床相关的低张力表现。
OBJECTIVE: Review hypotony failure criteria used in glaucoma surgical outcome studies and evaluate their impact on success rates.
METHODS: Systematic literature review and application of hypotony failure criteria to 2 retrospective cohorts.
METHODS: A total of 934 eyes and 1765 eyes undergoing trabeculectomy and deep sclerectomy (DS) with a median follow-up of 41.4 and 45.4 months, respectively.
METHODS: Literature-based hypotony failure criteria were applied to patient cohorts. Intraocular pressure (IOP)-related success was defined as follows: (A) IOP ≤ 21 mmHg with ≥ 20% IOP reduction; (B) IOP ≤ 18 mmHg with ≥ 20% reduction; (C) IOP ≤ 15 mmHg with ≥ 25% reduction; and (D) IOP ≤ 12 mmHg with ≥ 30% reduction. Failure was defined as IOP exceeding these criteria in 2 consecutive visits > 3 months after surgery, loss of light perception, additional IOP-lowering surgery, or hypotony. Cox regression estimated failure risk for different hypotony criteria, using no hypotony as a reference. Analyses were conducted for each criterion and hypotony type (i.e., numerical [IOP threshold], clinical [clinical manifestations], and mixed [combination of numerical or clinical criteria]).
METHODS: Hazard ratio (HR) for failure risk.
RESULTS: Of 2503 studies found, 278 were eligible, with 99 studies (35.6%) lacking hypotony failure criteria. Numerical hypotony was predominant (157 studies [56.5%]). Few studies used clinical hypotony (3 isolated [1.1%]; 19 combined with low IOP [6.8%]). Forty-nine different criteria were found, with IOP < 6 mmHg, IOP < 6 mmHg on ≥ 2 consecutive visits after 3 months, and IOP < 5 mmHg being the most common (41 [14.7%], 38 [13.7%], and 13 [4.7%] studies, respectively). In both cohorts, numerical hypotony posed the highest risk of failure (HR, 1.51-1.21 for criteria A to D; P < 0.001), followed by mixed hypotony (HR, 1.41-1.20 for criteria A to D; P < 0.001), and clinical hypotony (HR, 1.12-1.04; P < 0.001). Failure risk varied greatly with various hypotony definitions, with the HR ranging from 1.02 to 10.79 for trabeculectomy and 1.00 to 8.36 for DS.
CONCLUSIONS: Hypotony failure criteria are highly heterogenous in the glaucoma literature, with few studies focusing on clinical manifestations. Numerical hypotony yields higher failure rates than clinical hypotony and can underestimate glaucoma surgery success rates. Standardizing failure criteria with an emphasis on clinically relevant hypotony manifestations is needed.
BACKGROUND: Proprietary or commercial disclosure may be found after the references.