Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan.
PLoS One. 2021 Apr 15;16(4):e0249898. doi: 10.1371/journal.pone.0249898. eCollection 2021.
This study aimed to evaluate the 3-year long-term outcomes of primary Baerveldt glaucoma implant (BGI) surgery for neovascular glaucoma (NVG). We retrospectively evaluated 27 consecutive patients with NVG between November 2013 and November 2017. All the patients were treated with panretinal photocoagulation and pars plana vitrectomy before BGI surgery without anti-vascular endothelial growth factor treatment. The surgical success of the BGI was defined as an IOP of <22 mmHg and <5 mmHg with or without antiglaucoma medication. The outcomes were assessed on the basis of intraocular pressure (IOP), visual acuity, postoperative complications, and cumulative success rate. Except for 2 mortality cases, 25 eyes (92.6%) were followed up for 3 years. The mean IOPs (mmHg)/numbers of glaucoma medications ± standard error of the mean before and 12 and 36 months after BGI surgery were 41.6/4.6 ± 1.9/0.2, 14.8/2.2 ± 0.8/0.4 and 16.9/2.6 ± 1.1/0.3, respectively. In all of the follow-up time points, the postoperative mean IOP and number of glaucoma medications were statistically significantly lower than the preoperative values (analysis of variance, P < 0.001). At 3 years after surgery, the rates of visual acuity improvement (logMAR ≤ -0.3), invariance (-0.3 < logMAR < 0.3), and worsening (logMAR ≥ 0.3) were 56.0% (14/25 eyes), 24.0% (6/25 eyes), and 20.0% (5/25 eyes), respectively. The most common postoperative complications were hyphema (4 eyes, 14.8%) and vitreous hemorrhage (5 eyes, 18.5%), and serious complications such as expulsive hemorrhage, endophthalmitis, and tube/plate exposure did not occur. The cumulative probabilities of surgical success after the operation were 100% at 1 year, 85.2% at 2 years, and 77.4% at 3 years. In conclusion, combined non-valved pars plana tube placement in conjunction with vitrectomy was successful at lowering IOP with relatively low complication rates.
本研究旨在评估原发性 Baerveldt 青光眼植入物（BGI）治疗新生血管性青光眼（NVG）的 3 年长期疗效。我们回顾性评估了 2013 年 11 月至 2017 年 11 月期间 27 例 NVG 连续患者。所有患者均在 BGI 手术前接受全视网膜光凝和经睫状体扁平部玻璃体切除术治疗，未接受抗血管内皮生长因子治疗。BGI 手术的手术成功定义为眼压（IOP）<22mmHg 和<5mmHg，伴或不伴抗青光眼药物。根据眼压（IOP）、视力、术后并发症和累积成功率评估结果。除 2 例死亡病例外，25 只眼（92.6%）随访 3 年。BGI 手术后 12 个月和 36 个月的平均眼压（mmHg）/青光眼药物数量（±均数标准差）分别为 41.6/4.6±1.9/0.2、14.8/2.2±0.8/0.4 和 16.9/2.6±1.1/0.3。在所有随访时间点，术后平均眼压和青光眼药物数量均明显低于术前（方差分析，P<0.001）。术后 3 年，视力改善（logMAR≤-0.3）、不变（-0.3<logMAR<0.3）和恶化（logMAR≥0.3）的比例分别为 56.0%（14/25 眼）、24.0%（6/25 眼）和 20.0%（5/25 眼）。最常见的术后并发症是前房积血（4 只眼，14.8%）和玻璃体积血（5 只眼，18.5%），未发生严重并发症，如驱逐性出血、眼内炎和管/板暴露。术后 1 年、2 年和 3 年手术成功率的累积概率分别为 100%、85.2%和 77.4%。综上所述，联合非瓣膜睫状体扁平部引流管植入联合玻璃体切除术成功降低眼压，且并发症发生率相对较低。
