Kahook Dual Blade 内路小梁切开术后 6 个月内眼压升高的危险因素。
Risk factors for intraocular pressure elevation in a six-month period after ab interno trabeculotomy using a Kahook Dual Blade.
机构信息
Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
Department of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan.
出版信息
BMC Ophthalmol. 2022 Jul 30;22(1):327. doi: 10.1186/s12886-022-02545-1.
BACKGROUND
To examine the risk factors for an early postoperative intraocular pressure (IOP) increase after ab interno trabeculotomy using a Kahook Dual Blade (KDB trabeculotomy).
METHODS
A retrospective study was performed in 76 exfoliation glaucoma (EXG) eyes and 56 primary open angle glaucoma (POAG) eyes that underwent KDB trabeculotomy, with or without cataract surgery at Kumamoto University Hospital. Postoperative high IOP was classified as IOP≥20 mmHg (within three months after surgery, whether persistent or temporary), transient IOP≥20 mmHg (IOP≥20 mmHg after surgery, then dropped below 20 mmHg), and the presence of IOP spikes (≥ 10 mmHg from baseline). Risk factors were examined using logistic regression analysis.
RESULTS
The preoperative mean IOP (SD) was 24.98 (7.23) mmHg in patients with EXG and 21.28 (6.58) mmHg in patients with POAG. IOP was reduced by 32.1% in patients with EXG and by 17.7% in patients with POAG at 6 months after surgery. Postoperative IOP≥20 mmHg was observed in 56.6% of EXG patients and in 51.8% of POAG patients. IOP spikes occurred in 15.8% of EXG patients and in 14.3% of POAG patients. Logistic regression analysis showed that factors with significant odds ratios (ORs) were age (OR = 0.866, 95% CI = 0.793-0.945), preoperative medication use (OR = 2.02, 95% CI = 1.17-3.49), trabeculotomy in combination with cataract surgery (OR = 0.0674, 95% CI = 0.015-0.303), and IOP at day 1 (OR = 1.41, 95% CI = 1.18-1.68) for postoperative IOP≥20 mmHg, the IOP at day 1 (OR = 1.1, 95% CI = 1.03-1.17) for transient IOP≥20 mmHg, and age (OR = 0.948, 95% CI = 0.901-0.997) and preoperative IOP (OR = 0.83, 95% CI = 0.736-0.936) for IOP spikes.
CONCLUSION
Although KDB trabeculotomy is an effective treatment for patients with EXG and POAG, patients who take multiple preoperative medications and have a high IOP on day 1 require careful follow-up to prevent postoperative IOP elevation.
背景
本研究旨在探讨 Kahook 双切刀（KDB 小梁切开术）治疗内路小梁切开术后早期眼内压（IOP）升高的危险因素。
方法
回顾性分析在熊本大学医院接受 KDB 小梁切开术的 76 例剥脱性青光眼（EXG）眼和 56 例原发性开角型青光眼（POAG）眼的病历资料。根据术后是否发生高眼压将患者分为以下 3 组：术后 IOP≥20mmHg（术后 3 个月内，无论是否持续）、一过性 IOP≥20mmHg（术后 IOP 升高至≥20mmHg，随后降至＜20mmHg）和 IOP 峰值升高（与基线相比升高≥10mmHg）。采用 logistic 回归分析评估危险因素。
结果
EXG 患者术前平均眼压（SD）为 24.98（7.23）mmHg，POAG 患者为 21.28（6.58）mmHg。EXG 患者术后 6 个月眼压降低 32.1%，POAG 患者降低 17.7%。EXG 患者中术后 IOP≥20mmHg 的发生率为 56.6%，POAG 患者为 51.8%。EXG 患者中有 15.8%和 POAG 患者中有 14.3%发生 IOP 峰值升高。logistic 回归分析显示，具有显著比值比（OR）的因素为年龄（OR=0.866，95%可信区间=0.793-0.945）、术前用药（OR=2.02，95%可信区间=1.17-3.49）、小梁切开术联合白内障手术（OR=0.0674，95%可信区间=0.015-0.303）和术后第 1 天的眼压（OR=1.41，95%可信区间=1.18-1.68）与术后 IOP≥20mmHg 有关，术后第 1 天的眼压（OR=1.1，95%可信区间=1.03-1.17）与一过性 IOP≥20mmHg 有关，年龄（OR=0.948，95%可信区间=0.901-0.997）和术前眼压（OR=0.83，95%可信区间=0.736-0.936）与 IOP 峰值升高有关。
结论
虽然 KDB 小梁切开术是治疗 EXG 和 POAG 的有效方法，但对于术前使用多种药物且第 1 天眼压较高的患者，需要密切随访以预防术后眼压升高。
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