Välimäki Juha
Department of Ophthalmology, Päijät-Häme Central Hospital, Wellbeing Services County of Päijät-Häme, Lahti, 15850, Finland.
Clin Ophthalmol. 2023 Aug 9;17:2287-2293. doi: 10.2147/OPTH.S415406. eCollection 2023.
Larger surface area glaucoma drainage implant plates are associated with greater IOP reduction. Older age and short axial length of the eye have been reported to be risk factors for postoperative hypotony and suprachoroidal hemorrhage after glaucoma surgery. This pilot study, the first of its type, was conducted to determine the clinical outcome of intraoperative Baerveldt implant plate size reduction in elderly patients (≥80 years) with short axial length (<22 mm).
This was a retrospective study with a minimum 18-month follow-up involving 24 consecutive uncontrolled glaucoma patients who had previously undergone Baerveldt implantation with implant plate size reduction. Success was defined as intraocular pressure (IOP) < 21 mmHg with at least a 30% reduction in IOP from baseline on two consecutive follow-up visits, IOP > 5 mm Hg on two consecutive follow-up visits, and neither reoperation of glaucoma nor loss of light perception. The distance between the rectus muscles at the equator of the eyeball was measured using a surgical caliper. The Baerveldt implant plate was cut with straight dissecting scissors considering the distance between the muscles.
The mean ±SD preoperative IOP before GDI was 30.2 ± 6.9 mmHg, and the mean IOP at the last follow-up visit was 13.3 ± 5.1 mmHg, the mean pressure drop being 16.9 mmHg (56%) (<0.001). The number of antiglaucoma medications declined from mean 3.7 ± 1.0 (range 2-5) to 1.6 ± 1.1 (range 0-3) at the last visit (<0.001). The success rate at the last follow-up visit was 79% (19 of 24 eyes). Fourteen (58%) eyes were classified as qualified success and five eyes (21%) were complete success. Complications included intraoperative suprachoroidal hemorrhage (1) and postoperative hyphema (2).
Baerveldt implantation with customized plate downsizing can be an effective treatment option for difficult glaucoma in elderly people with short eyes.
更大表面积的青光眼引流植入物板与更大程度的眼压降低相关。据报道，年龄较大和眼轴较短是青光眼手术后低眼压和脉络膜上腔出血的危险因素。本项首例此类试点研究旨在确定在眼轴较短（<22mm）的老年患者（≥80岁）中术中减小Baerveldt植入物板尺寸的临床效果。
这是一项回顾性研究，对24例连续的未经控制的青光眼患者进行了至少18个月的随访，这些患者之前接受了Baerveldt植入并减小了植入物板尺寸。成功定义为眼压（IOP）<21mmHg，且在连续两次随访中眼压较基线至少降低30%，连续两次随访中眼压>5mmHg，且未进行青光眼再次手术且未丧失光感。使用手术卡尺测量眼球赤道处直肌之间的距离。根据肌肉之间的距离，用直解剖剪裁剪Baerveldt植入物板。
青光眼引流植入术前平均±标准差眼压为30.2±6.9mmHg，最后一次随访时平均眼压为13.3±5.1mmHg，平均眼压下降16.9mmHg（56%）（<0.001）。抗青光眼药物数量从平均3.7±1.0（范围2 - 5）降至最后一次随访时的1.6±1.1（范围0 - 3）（<0.001）。最后一次随访时成功率为79%（24只眼中的19只）。14只眼（58%）被归类为合格成功，5只眼（21%）为完全成功。并发症包括术中脉络膜上腔出血（1例）和术后前房积血（2例）。
定制板尺寸缩小的Baerveldt植入术对于短眼老年人的难治性青光眼可能是一种有效的治疗选择。
