Bhatt Anand, Oakey Zackery, Muniz-Castro Hannah, Mosaed Sameh
Gavin Herbert Eye Institute, Irvine, CA 92697,USA.
Irvine School of Medicine, University of California, Irvine, CA 92697, USA.
Vision (Basel). 2017 Jun 7;1(2):15. doi: 10.3390/vision1020015.
: Trabeculectomy is very effective in lowering intraocular pressure for the treatment of glaucoma, but it carries with it possible complications and failure. The ExPress shunt (Alcon Laboratories, Fort Worth, TX, USA) is an adjunctive device that can be used at the time of trabeculectomy to create an external fistuliztion. An alternative established and highly efficacious technique is the implantation of a glaucoma drainage device for sustained intraocular pressure (IOP) lowering. Specifically, evidence has established the Baerveldt 101-350 glaucoma implant (BGI) to have the best sustained IOP lowering in long-term follow-up amongst the many options for glaucoma drainage devices. : To compare outcomes in eyes that underwent Baerveldt 101-350 glaucoma implant (BGI) and trabeculectomy with ExPress shunt (Trab) in primary open angle glaucoma without any prior incisional glaucoma surgery. , , : This was a retrospective study of outcomes in patients identified by CPT codes as having undergone glaucoma implantation or trabeculectomy (with ExPress shunt) for the treatment of Primary Open Angle Glaucoma between 2012 and 2015 at a single institution by 2 fellowship trained glaucoma surgeons. A total of 57 eyes that underwent Baerveldt 101-350 glaucoma implant and 38 eyes that underwent trabeculectomy cases with ExPress™ shunt were included in the study. All patients were diagnosed with primary open angle glaucoma. Cases were included into the study if the patient underwent BGI or trabeculectomy with ExPress shunt without any prior incisional glaucoma surgery. Main outcomes included IOP, medications, visual acuity (VA), and secondary glaucoma surgery, if any. Results: Survival rate at 12 months was 85% in the BGI group and 80% in trabeculectomy with ExPress Shunt. A statistically significant difference was not found in the survival distributions between surgery groups using the log-rank test. A total of 12 trabeculectomy and 9 BGI cases failed by our definition of success. These cases were included in the analysis of IOP, number of glaucoma medications, and VA. The mean IOP was reduced from 20.6 ± 5.6 mmHg to 12.4 ± 3.2 mmHg and from 20.7 ± 5.5 mmHg to 11.3 ± 4.8 mmHg at one year post-operation in the BGI group and the trabeculectomy with ExPress shunt group, respectively. On average, the BGI group showed an IOP reduction of 7.7 ± 6.1 mmHg, while trabeculectomy with ExPress shunt experienced a decrease of 7.9 ± 5.2 mmHg at one year post-operation. Medications were reduced from 3.5 ± 0.8 to 2.6 ± 1.3 at one year in the BGI group and from 3.7 ± 0.5 to 0.6 ± 1.8 in the trabeculectomy with ExPress shunt group. At one year post-operation, the BGI group had an average of 0.9 ± 1.1 medication reduction, while trabeculectomy with ExPress shunt cases had a reduction of 3.2 ± 1.3 medications. VA was compared in logMar. At baseline, the average for BGI logMar was 0.5 ± 0.7 and the average for trabeculectomy was 0.2 ± 0.3. At one year post-operation, the BGI group's VA was 0.4 ± 0.4 while the trabeculectomy with ExPress shunt group's VA was 0.1 ± 0.1. The Baerveldt 101-350 glaucoma implant and trabeculectomy (with ExPress™ shunt) may have similar rates of success in the surgical treatment of primary open angle glaucoma in eyes that are naïve to prior incisional glaucoma surgery, with a higher dependence on topical medications post-operation in patients undergoing Baerveldt glaucoma implantation.
小梁切除术在降低眼压治疗青光眼方面非常有效，但它也可能带来并发症和手术失败。ExPress分流器（美国德克萨斯州沃思堡市爱尔康实验室）是一种辅助装置，可在小梁切除术时用于建立外部瘘管。另一种成熟且高效的技术是植入青光眼引流装置以持续降低眼压（IOP）。具体而言，有证据表明，在众多青光眼引流装置中，Baerveldt 101 - 350青光眼植入物（BGI）在长期随访中具有最佳的持续降低眼压效果。
为比较在原发性开角型青光眼且未接受过任何先前切开性青光眼手术的患者中，接受Baerveldt 101 - 350青光眼植入物（BGI）和小梁切除术联合ExPress分流器（Trab）的手术效果。
这是一项回顾性研究，研究对象是由CPT编码确定在2012年至2015年期间于单一机构接受青光眼植入术或小梁切除术（联合ExPress分流器）以治疗原发性开角型青光眼的患者。该研究共纳入57只接受Baerveldt 101 - 350青光眼植入物的眼睛和38只接受小梁切除术联合ExPress™分流器的眼睛。所有患者均被诊断为原发性开角型青光眼。如果患者接受BGI或小梁切除术联合ExPress分流器且未接受过任何先前切开性青光眼手术，则将其病例纳入研究。主要观察指标包括眼压、用药情况、视力（VA）以及二次青光眼手术（如有）。结果：BGI组12个月时的生存率为85%，小梁切除术联合ExPress分流器组为80%。使用对数秩检验未发现手术组之间的生存分布存在统计学显著差异。根据我们对成功的定义，共有12例小梁切除术和9例BGI病例失败。这些病例被纳入眼压、青光眼用药数量和视力的分析。BGI组术后一年平均眼压从20.6±5.6 mmHg降至12.4±3.2 mmHg，小梁切除术联合ExPress分流器组从20.7±5.5 mmHg降至11.3±4.8 mmHg。平均而言，BGI组术后一年眼压降低7.7±6.1 mmHg，小梁切除术联合ExPress分流器组降低7.9±5.2 mmHg。BGI组用药数量从3.5±0.8降至术后一年的2.6±1.3，小梁切除术联合ExPress分流器组从3.7±0.5降至0.6±1.8。术后一年，BGI组平均用药减少0.9±1.1，小梁切除术联合ExPress分流器组用药减少3.2±1.3。视力以对数最小分辨角（logMar）进行比较。基线时，BGI组logMar平均为0.5±0.7，小梁切除术组平均为0.2±0.3。术后一年，BGI组视力为0.4±0.。小梁切除术联合ExPress分流器组视力为0.1±0.1。在未接受过先前切开性青光眼手术的原发性开角型青光眼患者的手术治疗中，Baerveldt 101 - 350青光眼植入物和小梁切除术（联合ExPress™分流器）可能具有相似的成功率，接受Baerveldt青光眼植入术的患者术后对局部用药的依赖性更高。
