Chang Enchi K, Gupta Sanchay, Hall Nathan, Neeson Cameron E, Chang Ta C, Solá-Del Valle David A
Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
Massachusetts Eye and Ear, Boston, Massachusetts.
Ophthalmol Glaucoma. 2022 Mar-Apr;5(2):219-228. doi: 10.1016/j.ogla.2021.08.007. Epub 2021 Sep 6.
To compare outcomes of glaucoma drainage device (GDD) implantation and trabeculectomies with and without postoperative intravitreal injections (IVIs) in glaucoma patients with a history of preoperative IVIs.
Retrospective cohort study.
A total of 133 eyes of 133 glaucoma patients who underwent GDD implantation or trabeculectomy with at least 1 IVI preoperatively between January 2005 and October 2020 at Massachusetts Eye and Ear.
Chart review of glaucoma patients with traditional glaucoma surgery and at least 1 IVI before surgery. All statistical analyses were conducted with R statistical programming software.
Intraocular pressure (IOP), medication burden, best-corrected visual acuity (BCVA), Kaplan-Meier success rates, adjusted hazard ratios (HRs), and complications.
Baseline demographics were similar between the groups with and without postoperative IVIs. The group with postoperative IVIs had a higher proportion of diabetic retinopathy and retinal vascular occlusions than the group without postoperative IVIs, which had more eyes with age-related macular degeneration. Intraocular pressure, medication burden, and visual acuity were similar between groups at all time points except for IOP at 6 weeks, which was lower in the group with postoperative IVIs. The group with postoperative IVIs had significantly more preoperative IVIs than the group without postoperative IVIs (6.6 vs. 3.3, P = 0.017). For success defined as IOP reduction ≥ 20% with 5 < IOP ≤ 21 mmHg, Kaplan-Meier analyses demonstrated similar success rates between groups with and without IVIs. When stratified by the number of IVIs, success rates for the group with 7 or more IVIs were significantly higher than the success rates for the group with 0-6 IVIs (P = 0.005). Each additional postoperative IVI resulted in a 7.2% decrease in the hazard of failure to achieve our stated success criteria. With regard to late complications, the group with postoperative IVIs had a higher incidence of vitreous hemorrhage (18.5% vs. 3.2%, P = 0.039) than the group without postoperative IVIs.
A higher number of postoperative IVIs, specifically 7 or more IVIs, may be associated with improved success rates of traditional glaucoma surgery in glaucoma patients who received IVIs before surgery.
比较青光眼引流装置（GDD）植入术和小梁切除术在术前有玻璃体内注射（IVI）病史的青光眼患者中的疗效，以及术后是否进行IVI的情况。
回顾性队列研究。
2005年1月至2020年10月在马萨诸塞州眼耳医院接受GDD植入术或小梁切除术且术前至少进行过1次IVI的133例青光眼患者的133只眼睛。
对接受传统青光眼手术且术前至少进行过1次IVI的青光眼患者进行病历回顾。所有统计分析均使用R统计编程软件进行。
眼压（IOP）、药物负担、最佳矫正视力（BCVA）、Kaplan-Meier成功率、调整后的风险比（HRs）和并发症。
术后进行IVI和未进行IVI的两组患者的基线人口统计学特征相似。术后进行IVI的组中糖尿病视网膜病变和视网膜血管阻塞的比例高于未进行术后IVI的组，而后者年龄相关性黄斑变性的眼睛更多。除了术后6周时的眼压（术后进行IVI的组较低）外，两组在所有时间点的眼压、药物负担和视力相似。术后进行IVI的组术前IVI次数明显多于未进行术后IVI的组（6.6次对3.3次，P = 0.017）。对于定义为眼压降低≥20%且5 <眼压≤21 mmHg的成功标准，Kaplan-Meier分析显示进行IVI和未进行IVI的两组成功率相似。按IVI次数分层时，进行7次或更多IVI的组的成功率明显高于进行0 - 6次IVI的组（P = 0.005）。每次额外的术后IVI会使未达到既定成功标准的失败风险降低7.2%。关于晚期并发症，术后进行IVI的组玻璃体积血的发生率高于未进行术后IVI的组（18.5%对3.2%，P = 0.039）。
在术前接受过IVI的青光眼患者中，更多的术后IVI，特别是7次或更多次IVI，可能与传统青光眼手术成功率的提高有关。
