Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada; Department of Ophthalmology, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, Quebec, Canada.
Am J Ophthalmol. 2020 Jul;215:141-153. doi: 10.1016/j.ajo.2020.02.020. Epub 2020 Mar 13.
To determine the efficacy, risk factors for failure, and adverse events of a standalone novel ab externo SIBS microshunt with mitomycin C (MMC) during 1-year follow-up.
Retrospective, interventional case series.
Glaucomatous eyes with an intraocular pressure (IOP) above target and/or progressing on maximally tolerated medical therapy.
Consecutive patients with open-angle glaucoma (OAG) and no previous filtering surgery received an ab externo SIBS microshunt with MMC from July 2015 to November 2017. Main outcome measures were proportion of eyes at 1-year with (1) no 2 consecutive IOP readings >17 mm Hg or clinical hypotony without (complete) or with glaucoma medications (qualified); and (2) at least a 20% reduction from decision IOP. Secondary outcomes included upper IOP thresholds of 14 mm Hg and 21 mm Hg with and without a 20% IOP reduction from baseline, median IOP, medications, risk factors for failure, interventions, complications, and reoperations.
A total of 164 eyes in 132 patients were included. Complete success was achieved in 76.9% of eyes, qualified success in 92.5%. Complete success was 75.6% for an upper IOP cut-off of 14 mm Hg and 76.9% for 21 mm Hg, and qualified success was 91.9% and 92.5%. MMC dose of 0.2 vs 0.4-0.5 mg/mL (hazard ratio [HR] 2.51; 95% CI 1.12-5.65) and primary open-angle glaucoma vs secondary open-angle glaucoma (SOAG) (HR 2.51; 95% CI 1.01-6.23) represented the only risk factors for failure in multivariable analysis. Needling was performed in 8.5% of eyes. Two eyes received surgical revision, and 1 a reoperation.
One-year results of the ab externo SIBS microshunt demonstrated promising rates of qualified and complete success, decreased drop use, few complications, and infrequent postoperative interventions.
在 1 年的随访中，确定新型经巩膜睫状体沟引流阀（SIBS）联合丝裂霉素 C（MMC）治疗的疗效、失败的危险因素和不良事件。
回顾性、干预性病例系列。
眼压（IOP）高于目标值且/或经最大耐受药物治疗仍进展的青光眼患者。
2015 年 7 月至 2017 年 11 月，连续收治行外路 SIBS 微引流阀联合 MMC 治疗的开角型青光眼（OAG）患者，不合并既往滤过性手术史。主要观察指标是 1 年时（1）无 2 次连续 IOP 读数>17mmHg 或临床低眼压而无需（完全）或需要青光眼药物（合格）；和（2）与基线相比IOP 至少降低 20%的眼的比例。次要观察指标包括眼压为 14mmHg 和 21mmHg 时的上界阈值，以及与基线相比IOP 降低 20%时的中位数、药物、失败的危险因素、干预措施、并发症和再手术。
共纳入 132 例患者的 164 只眼。76.9%的眼达到完全成功，92.5%的眼达到合格成功。眼压上限为 14mmHg 时完全成功率为 75.6%，眼压上限为 21mmHg 时为 76.9%，合格成功率分别为 91.9%和 92.5%。MMC 剂量为 0.2mg/mL 与 0.4-0.5mg/mL 相比（风险比[HR]2.51；95%置信区间[CI]1.12-5.65）和原发性开角型青光眼与继发性开角型青光眼（SOAG）相比（HR 2.51；95% CI 1.01-6.23）是多变量分析中唯一的失败危险因素。8.5%的眼需要行针刺术。2 只眼接受了手术修正，1 只眼接受了再手术。
外路 SIBS 微引流阀治疗 1 年的结果显示出有前景的合格和完全成功率、减少滴眼次数、较少的并发症和术后干预频率。
