眼表干细胞移植术后继发青光眼行巩膜睫状体光凝术与青光眼引流装置的比较。

Comparison of Glaucoma Drainage Device Versus Transscleral Cyclophotocoagulation for Secondary Glaucoma Following Ocular Surface Stem Cell Transplantation.

机构信息

Cincinnati Eye Institute.

University of Cincinnati, Cincinnati, OH.

出版信息

J Glaucoma. 2021 Mar 1;30(3):e119-e122. doi: 10.1097/IJG.0000000000001723.

DOI:10.1097/IJG.0000000000001723

PMID:33137017

Abstract

PRCIS

Rates of ocular surface failure and glaucoma reoperation were similar between cyclophotocoagulation (CPC) and glaucoma drainage devices (GDDs). CPC is a safe option in the management of secondary glaucoma after ocular surface stem cell transplantation (OSST).

PURPOSE

To assess surgical and ocular surface outcomes in patients requiring glaucoma surgery after OSST.

MATERIALS AND METHODS

Retrospective chart review of eyes with previous OSST that underwent either transscleral CPC or implantation of a GDD. Primary outcomes were ocular surface failure (defined as recurrence of corneal conjunctivalization with late fluorescein staining) and glaucoma surgery failure (defined as the need for additional glaucoma surgery, including repeat treatment or revision). Secondary outcomes were changes in intraocular pressure (IOP) and number of glaucoma medications. Additional subgroup analysis was performed for subtypes of CPC and GDD.

RESULTS

Thirty-six glaucoma surgeries (7 Ahmed, 19 Baerveldt, and 10 CPC) were performed in 31 eyes with a history of prior OSST. The ocular surface failure rate was 19% for GDDs and 10% for CPC (P=0.65). Additional glaucoma surgery was needed for 38% of GDDs and 70% of CPC (P=0.14). The mean IOP reduction was 50% for GDDs and 28% for CPC (P=0.05). The mean drop reduction was 1.6 for GDDs and 0.1 for CPC (P=0.02). All glaucoma failures in the GDD group were related to tube erosion and/or hypotony, whereas all glaucoma failures in the CPC group were because of uncontrolled IOP. There were no significant differences in primary or secondary outcomes between CPC or GDD subgroups.

CONCLUSION

Glaucoma is a frequent comorbidity in patients with severe ocular surface disease, and treatment poses unique challenges in those with prior OSST. In this study, ocular surface failure and glaucoma reoperation rates were similar between CPC and GDD groups, suggesting that CPC, including repeat treatment, is a safe option for the management of secondary glaucoma after OSST. A multidisciplinary approach is recommended in the management of these complex eyes.

摘要

PRCIS

在睫状体光凝术（CPC）和青光眼引流装置（GDD）之间，眼表面失败和青光眼再次手术的发生率相似。CPC 是眼表干细胞移植（OSST）后治疗继发性青光眼的安全选择。

目的

评估需要行青光眼手术的 OSST 后患者的手术和眼表结果。

材料和方法

回顾性分析既往行 OSST 后行巩膜 CPC 或 GDD 植入术的患者的病历。主要结局为眼表失败（定义为角膜结膜化伴晚期荧光素染色复发）和青光眼手术失败（定义为需要额外的青光眼手术，包括重复治疗或修正）。次要结局为眼压（IOP）和青光眼药物数量的变化。还对 CPC 和 GDD 的亚组进行了亚组分析。

结果

31 只眼既往有 OSST 史，共行 36 例青光眼手术（7 例 Ahmed、19 例 Baerveldt 和 10 例 CPC）。GDD 的眼表失败率为 19%，CPC 为 10%（P=0.65）。GDD 组有 38%需要再次行青光眼手术，CPC 组有 70%（P=0.14）。GDD 组的平均 IOP 降低 50%，CPC 组为 28%（P=0.05）。GDD 组的平均药物滴数减少 1.6，CPC 组为 0.1（P=0.02）。GDD 组所有的青光眼失败都与引流管侵蚀和/或低眼压有关，而 CPC 组所有的青光眼失败都是由于眼压控制不佳。CPC 或 GDD 亚组之间的主要或次要结局均无显著差异。