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小梁切除术后低眼压患者的危险因素和长期疗效

Tseng, V.L., Kim, C.H., Romero, P.T., et al.

期刊名称:Ophthalmology

卷期:2017年第124卷第10期

摘要

摘要:目的:旨在检查小梁切除术后低眼压(IOP)的危险因素,并描述这些眼的长期预后。设计:回顾性病例对照研究。研究对象:低IOP患者,包括所有小梁切除术后3个月以上I3次以上连续就诊OP5mmHg的患者。小梁切除术后无低眼压对照患者按12比例随机选择。方法:对Stein 眼科研究所进行小梁切除术的患者进行病例对照研究。协变量包括人口统计学,白内障手术史,屈光不正,青光眼药物数量,青光眼家族史,糖尿病,高血压,视力(VA),IOP,巩膜瓣缝合数,激光断线术,外科医生和偏重一侧的手术。 使用Logistic回归模型检查每个协变量和低IOP之间的关联。检查的术后预后指标包括再手术,视力丧失和手术失败。采用Cox比例风险回归模型比较病例组和对照组之间小梁切除术与各预后之间的时间。主要观察指标:小梁切除术后低眼压,再次手术和手术失败。结果:1990年至2003年间,由5名外科医生进行的3659例小梁切除术中,64只出现低眼眼(1.7%),对照组则有130只眼。 64只低眼压患者中有15例出现低眼压性黄斑病变(23.4%)。考虑到基线眼压差异,激光断线术与小梁切除术后的低IOP呈负相关(OR0.33; 95%可信区间[CI]0.13-0.87;医生与小梁切除术后高或低IOP相关(OR5.32; 95CI1.53-18.52)。低IOP和再手术时间(HR0.73; 95CI0.32-1.68),视力丧失(HR1.77; 95CI0.81-3.88)或手术失败( HR1.14; 95CI0.62-2.11)之间无统计学意义。在眼压低的患者中,患有黄斑病变的患者的大疱修复发生率较高(黄斑病变与无黄斑病变7.61.9修订/ 100人年); P = 0.008)。结论:激光断线术与医生是小梁切除术后低IOP的可能相关因素。低压数字并不一定代表小梁切除术后临床失败。

PURPOSE:To examine risk factors for low intraocular pressure (IOP) after trabeculectomy and to describe long-term outcomes in these eyes.DESIGN:Retrospective case-control study.PARTICIPANTS:Cases with low IOP included all patients with IOP 5 mmHg on 3 or more consecutive visits 3 months or later after trabeculectomy. Control patients without low IOP after trabeculectomy were randomly selected at a 1:2 case-to-control ratio.METHODS:A case-control study was performed of patients undergoing trabeculectomy at the Stein Eye Institute. Covariates included demographics, history of cataract surgery, refractive error, number of glaucoma medications, family history of glaucoma, diabetes, hypertension, visual acuity (VA), IOP, number of sutures in the scleral flap, laser suture lysis, surgeon, and laterality of surgery. Logistic regression modeling was used to examine associations between each covariate and low IOP. Postoperative outcomes that were examined included reoperation, vision loss, and surgical failure. The time between trabeculectomy and each outcome was compared between cases and controls with Cox proportional hazards regression modeling.MAIN OUTCOME MEASURES:Low IOP after trabeculectomy, reoperation, vision loss, and surgical failure.RESULTS:Of 3659 total trabeculectomies performed by 5 surgeons between 1990 and 2013, 64 eyes had low IOP (1.7%), which were compared with 130 control eyes. Fifteen of the 64 eyes with low IOP had hypotony maculopathy (23.4%). After accounting for differences in baseline IOP, laser suture lysis was negatively correlated with low IOP after trabeculectomy (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.13-0.87); surgeon was correlated with high vs. low IOP after trabeculectomy (OR, 5.32; 95% CI, 1.53-18.52). There were no statistically significant associations between low IOP and time to reoperation (hazard ratio [HR], 0.73; 95% CI, 0.32-1.68), vision loss (HR, 1.77; 95% CI, 0.81-3.88) or surgical failure (HR, 1.14; 95% CI, 0.62-2.11). In patients with low IOP, there was a higher unadjusted incidence of bleb revision in patients who had maculopathy (7.6 vs. 1.9 revisions/100 person-years; for maculopathy versus no maculopathy P = 0.008).CONCLUSIONS:The absence of laser suture lysis and surgeon are factors potentially associated with low IOP after trabeculectomy. Numeric hypotony does not necessarily represent clinical failure after trabeculectomy.


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