Tan Nicholas E, Chen Shannon X, Fang Alexander H, Radcliffe Nathan M
College of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA.
Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY, USA.
Ophthalmol Ther. 2022 Dec;11(6):2083-2100. doi: 10.1007/s40123-022-00565-0. Epub 2022 Sep 10.
This study compared the safety and efficacy of sutureless Ahmed glaucoma valve surgery (AGV standalone) to sutureless AGV plus cataract surgery (AGV-CEIOL) in Black or Hispanic patients.
Records from Black or non-white Hispanic patients who received either AGV standalone or AGV-CEIOL from 2014 to 2019 at a Bronx, New York practice were reviewed. All surgeries were performed using a sutureless technique with Tisseel fibrin glue. Primary outcomes included failure (defined as intraocular pressure (IOP) > 21 mmHg, ≤ 5 mmHg, or reduced by < 20% after the first 3 months; loss of light perception; or reoperation for glaucoma), hypertensive phase, IOP changes, and medication changes. Secondary outcomes included postoperative complications and interventions.
A total of 203 eyes that received AGV standalone (n = 78) or AGV-CEIOL (n = 125) were analyzed. Mean follow-up duration was 42.2 ± 17.5 months, with similar cohort-specific intervals (P = 0.68). Failure among AGV-CEIOLs (44.8%, n = 56) and AGV standalones (47.4%, n = 37) occurred at similar frequencies; log-rank testing indicated comparable 5-year survival (P = 0.56). Mean IOP among AGV-CEIOLs (15.8 ± 12.1 mmHg) was greater than standalones (8.6 ± 5.1 mmHg) at post-op day 1 (P < 0.001). The AGV-CEIOL group had a 60% lower odds of experiencing a hypertensive phase after adjustment for baseline group differences (P = 0.01). Five-year IOP reduction was similar between groups in the multivariable model (P = 0.45). There were no significant differences in medications (P > 0.05 at all time points) or in total complications (P = 0.28). More standalones required reoperation (39.7%, n = 31) compared to AGV-CEIOLs (21.6%, n = 24; P = 0.007).
Sutureless AGV-CEIOL was noninferior to sutureless AGV standalone when performed in Black or non-white Hispanic patients. The combined group experienced the hypertensive phase less frequently despite higher day 1 IOP.
本研究比较了无缝合艾哈迈德青光眼引流阀手术（单独AGV）与无缝合AGV联合白内障手术（AGV-CEIOL）在黑人或西班牙裔患者中的安全性和有效性。
回顾了2014年至2019年在纽约布朗克斯一家诊所接受单独AGV或AGV-CEIOL手术的黑人或非白人西班牙裔患者的记录。所有手术均采用无缝合技术并使用纤维蛋白胶Tisseel。主要结局包括手术失败（定义为眼压（IOP）>21 mmHg、≤5 mmHg或在最初3个月后降低<20%；光感丧失；或因青光眼再次手术）、高血压期、IOP变化和药物变化。次要结局包括术后并发症和干预措施。
共分析了203只接受单独AGV（n = 78）或AGV-CEIOL（n = 125）手术的眼睛。平均随访时间为42.2±17.5个月，各队列特定随访时间相似（P = 0.68）。AGV-CEIOL组（44.8%，n = 56）和单独AGV组（47.4%，n = 37）的手术失败频率相似；对数秩检验显示5年生存率相当（P = 0.56）。术后第1天，AGV-CEIOL组的平均IOP（15.8±12.1 mmHg）高于单独AGV组（8.6±5.1 mmHg）（P < 0.001）。在对基线组差异进行调整后，AGV-CEIOL组出现高血压期的几率低60%（P = 0.01）。在多变量模型中，两组间5年的IOP降低情况相似（P = 0.45）。药物使用情况（所有时间点P > 0.05）或总并发症方面均无显著差异（P = 0.28）。与AGV-CEIOL组（21.6%，n = 24；P = 0.007）相比，单独AGV组需要再次手术的比例更高（39.7%，n = 31）。
在黑人或非白人西班牙裔患者中进行手术时，无缝合AGV-CEIOL不劣于无缝合单独AGV。尽管术后第1天IOP较高，但联合手术组出现高血压期的频率较低。
