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葡萄膜炎性青光眼行 Baerveldt 青光眼引流植入术的危险因素。

Risk factors for Baerveldt glaucoma drainage implantation for uveitic glaucoma.

机构信息

Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.

Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan.

出版信息

Sci Rep. 2023 Mar 18;13(1):4473. doi: 10.1038/s41598-023-29244-1.

Abstract

Uveitic glaucoma (UG) is sometimes intractable, including intricate interaction between intraocular pressure (IOP) elevation associated with inflammation and side effects of steroids. Based on the Tube Versus Trabeculectomy study in refractory glaucoma results in 2012, tube shunt surgeries have been performed for UG, but few reports have focused on UG. We retrospectively examined the surgical efficacy, complications, and risk factors in 62 eyes with UG that underwent Baerveldt glaucoma drainage device (BGD) implantation at Kumamoto University. The IOPs significantly dropped, and the mean number of glaucoma medications was reduced by more than two. Kaplan‒Meier survival curves were presented under 2 conditions: an IOP reduction of 20% and 6 ≤ IOP ≤ 18 mmHg (criterion A) or 6 ≤ IOP ≤ 15 mmHg (criterion B). In criterion A, the median survival times (MST) were 124 days (complete) and 997 days (qualified). In criterion B, the MST was 129 days (complete) and 867 days (qualified). The Cox hazard proportional model found that the hazard ratio was 0.170 for a history of cataract surgery (95% CI 0.0303-0.950) and 8.669 for systemic immunosuppressive therapy (95% CI 1.810-41.51). BGD implantation is effective for treating UG, but the presence of systemic treatment and the lens status should be considered.

摘要

葡萄膜炎相关性青光眼(UG)有时难以治疗,包括眼压升高与炎症之间的复杂相互作用以及类固醇的副作用。基于 2012 年难治性青光眼的 Tube Versus Trabeculectomy 研究结果,已经对 UG 进行了管分流手术,但很少有报道专门针对 UG。我们回顾性检查了在熊本大学接受 Baerveldt 青光眼引流装置(BGD)植入术的 62 只 UG 眼的手术效果、并发症和危险因素。眼压显著下降,平均降眼压药物数量减少超过两种。根据 2 种情况(眼压降低 20%和 6≤眼压≤18mmHg(标准 A)或 6≤眼压≤15mmHg(标准 B))呈现 Kaplan-Meier 生存曲线。在标准 A 下,中位生存时间(MST)分别为 124 天(完全)和 997 天(合格)。在标准 B 下,MST 为 129 天(完全)和 867 天(合格)。Cox 风险比例模型发现,白内障手术史的风险比为 0.170(95%CI 0.0303-0.950),全身免疫抑制治疗为 8.669(95%CI 1.810-41.51)。BGD 植入术治疗 UG 有效,但应考虑全身治疗和晶状体状态。

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