Shalaby Wesam Shamseldin, Patel Sonali, Lam Sophia S, Bechay Joseph, Zadrozny Izabella, Reyes Johannie, Zhang Qiang, Sharpe James, Lee Daniel, Myers Jonathan S, Kolomeyer Natasha Nayak, Razeghinejad Reza, Pro Michael J, Moster Marlene R, Garg Shukla Aakriti
Wills Eye Hospital, Glaucoma Research Center.
Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt.
J Glaucoma. 2023 May 1;32(5):389-395. doi: 10.1097/IJG.0000000000002173. Epub 2023 Jan 26.
In this retrospective study, the use of chronic antithrombotic therapy (ATT) did not increase the risk of hemorrhagic complications after trabecular bypass microstent surgery and phacoemulsification. Stent type and female sex were associated with hyphema.
To report the incidence of hemorrhagic complications after trabecular bypass microstent surgery and phacoemulsification with and without (ATT).
Retrospective case series on glaucoma patients on chronic ATT who underwent trabecular bypass microstent surgery (iStent, iStent inject, and Hydrus) combined with phacoemulsification between 2013 and 2019 with ≥3-month follow-up. The primary outcome measure was the incidence of hemorrhagic complications within a 3-month postoperative period. Generalized estimating equations were created to account for inter-eye correlation and logistic regression analysis was performed to identify factors predictive of hemorrhagic complications.
Of 333 patients (435 eyes), 161 patients (211 eyes) were on ATT and 172 patients (224 eyes) were not on ATT; both groups were similar in age and baseline ocular characteristics. The only hemorrhagic complication was hyphema, which occurred in 84 (19.3%) eyes (41 ATT, 43 non-ATT eyes; P = 1.00). Onset was at postoperative day 1 in 98.8% of eyes, with a duration of 1 week in 73.8% of eyes, without difference between ATT and non-ATT groups. Hyphema was most common with Hydrus microstent (36.4%) versus iStent (19.9%) and iStent inject (8.5%) ( P = 0.003). In the multivariate model, the female sex was a predictor of hyphema [hazard ratio (HR) = 2.062; P = 0.009], iStent inject was protective against hyphema (HR = 0.379; P = 0.033), whereas Hydrus did not reach statistical significance (HR = 2.007; P = 0.081). Age, systemic comorbidities, ATT use, and baseline ocular characteristics were not significant predictors.
Hemorrhagic complications after trabecular bypass microstent surgery were limited to transient hyphema and were not associated with chronic ATT use. Stent type and female sex were associated with hyphema.
在这项回顾性研究中，慢性抗血栓治疗（ATT）的使用并未增加小梁旁路微支架手术和白内障超声乳化术后出血并发症的风险。支架类型和女性性别与前房积血相关。
报告小梁旁路微支架手术和白内障超声乳化术在使用和未使用（ATT）情况下出血并发症的发生率。
对2013年至2019年间接受小梁旁路微支架手术（iStent、iStent inject和Hydrus）联合白内障超声乳化术且进行了≥3个月随访的慢性ATT青光眼患者进行回顾性病例系列研究。主要结局指标是术后3个月内出血并发症的发生率。创建广义估计方程以考虑眼间相关性，并进行逻辑回归分析以确定出血并发症的预测因素。
在333例患者（435只眼）中，161例患者（211只眼）接受ATT治疗，172例患者（224只眼）未接受ATT治疗；两组在年龄和基线眼部特征方面相似。唯一的出血并发症是前房积血，发生在84只眼（19.3%）（41只接受ATT治疗的眼，43只未接受ATT治疗的眼；P = 1.00）。98.8%的眼在前房积血在术后第1天出现，73.8%的眼持续1周，接受ATT治疗组和未接受ATT治疗组之间无差异。Hydrus微支架导致的前房积血最为常见（36.4%），而iStent为19.9%，iStent inject为8.5%（P = 0.003）。在多变量模型中，女性性别是前房积血的预测因素[风险比（HR）= 2.062；P = 0.009]，iStent inject可预防前房积血（HR = 0.379；P = 0.033），而Hydrus未达到统计学意义（HR = 2.007；P = 0.081）。年龄、全身合并症、ATT的使用以及基线眼部特征不是显著的预测因素。
小梁旁路微支架手术后的出血并发症仅限于短暂性前房积血，且与慢性ATT的使用无关。支架类型和女性性别与前房积血相关。
