Ying Stephanie, Coulon Sara J, Lidder Alcina K, Labowsky Mary, Cheng Christopher P, Vinod Kateki, Sidoti Paul A, Panarelli Joseph F
Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Ophthalmology, New York University Langone Health, New York, New York.
Ophthalmol Glaucoma. 2023 Sep-Oct;6(5):530-540. doi: 10.1016/j.ogla.2023.03.002. Epub 2023 Mar 15.
To report the incidence of patients who developed choroidal effusions after glaucoma drainage implant (GDI) surgery and determine risk factors for and outcomes of surgical intervention.
Retrospective case series.
Medical records of 605 patients who underwent GDI surgery from January 1, 2017 to June 7, 2021 at New York University Langone Health and New York Eye and Ear Infirmary of Mount Sinai were reviewed.
Preoperative, intraoperative, and postoperative clinical data were obtained. Multivariate logistic regression evaluated the factors associated with the need for surgical intervention. Patient records were analyzed for effusion resolution, intraocular pressure (IOP), visual acuity (VA), and complications across treatment modalities.
Incidence of choroidal effusion development and need for surgical intervention.
Choroidal effusions developed in 110 (18%) patients (110 eyes). Surgical intervention to drain the effusion or ligate the implant tube was performed in 19 (17%) patients. The average time to surgical intervention was 47.6 days. Among patients who developed postoperative effusions, risk factors for requiring surgical intervention included history of selective laser trabeculoplasty (SLT) (P = 0.004; odds ratio [OR], 14.4), prior GDI surgery (P = 0.04; OR 8.7), 350-mm Baerveldt glaucoma implant placement (P = 0.05; OR, 4.8), and anterior chamber shallowing (AC; P < 0.001; OR, 25.1) in the presence of effusions. The subgroup that required multiple surgeries for effusion resolution had a significantly lower mean IOP at the most recent follow-up compared with those who received medical management only (P < 0.001). A higher percentage of patients who required surgical intervention lost VA at the most recent follow-up compared with patients whose effusions resolved with conservative management (i.e., medical management, AC viscoelastic injection).
Choroidal effusions after GDI surgery resolved with conservative management in most patients. A history of SLT or GDI placement, implantation of a BGI-350, and the presence of a shallow chamber were risk factors for surgical intervention. Although interventions, such as surgical drainage are at times necessary, a better understanding of their impacts can help guide postoperative decisions. The risks and benefits of these procedures must be carefully considered in these high-risk eyes.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
报告青光眼引流植入物（GDI）手术后发生脉络膜积液的患者发生率，并确定手术干预的危险因素和结果。
回顾性病例系列研究。
回顾了2017年1月1日至2021年6月7日在纽约大学朗格尼健康中心和西奈山纽约眼耳医院接受GDI手术的605例患者的病历。
获取术前、术中和术后的临床数据。多因素逻辑回归分析评估与手术干预需求相关的因素。分析患者记录以了解积液消退情况、眼压（IOP）、视力（VA）以及不同治疗方式的并发症。
脉络膜积液的发生率及手术干预需求。
110例（18%）患者（110只眼）发生脉络膜积液。19例（17%）患者接受了引流积液或结扎植入管的手术干预。手术干预的平均时间为47.6天。在发生术后积液的患者中，需要手术干预的危险因素包括选择性激光小梁成形术（SLT）史（P = 0.004；比值比[OR]，14.4）、既往GDI手术史（P = 0.04；OR 8.7）、植入350-mm Baerveldt青光眼植入物（P = 0.05；OR，4.8）以及积液存在时前房变浅（AC；P < 0.001；OR，25.1）。与仅接受药物治疗的患者相比，需要多次手术解决积液的亚组在最近一次随访时的平均眼压显著更低（P < 0.001）。与积液通过保守治疗（即药物治疗、前房黏弹剂注射）消退的患者相比，需要手术干预的患者在最近一次随访时视力丧失的比例更高。
大多数GDI手术后的脉络膜积液患者通过保守治疗得以消退。SLT或GDI植入史、植入BGI-350以及前房变浅是手术干预的危险因素。尽管有时需要手术引流等干预措施，但更好地了解其影响有助于指导术后决策。对于这些高危眼，必须仔细权衡这些手术的风险和益处。
本文末尾的脚注和披露中可能包含专有或商业披露信息。
