From the Department of Ophthalmology (A.R., P.D., A.C., S.D.C.), University Hospital Maggiore della Carità, Novara, Italy; Department of Health Sciences (A.R., S.D.C.), Università del Piemonte Orientale "Amedeo Avogadro", Novara, Italy.
Department of Ophthalmology (R.T., P.B., C.C., F.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy.
Am J Ophthalmol. 2024 Mar;259:117-130. doi: 10.1016/j.ajo.2023.11.011. Epub 2023 Nov 17.
To evaluate risk factors for failure of Microshunt in glaucoma patients.
Multicenter retrospective cohort study.
The study included 220 eyes from 220 consecutive glaucoma patients undergoing Microshunt implantation at six glaucoma units. Four intraocular pressure (IOP) success criteria were defined: (A) IOP ≤21 mm Hg with ≥20% IOP reduction; (B) IOP ≤18 mm Hg with ≥20% IOP reduction; (C) IOP ≤15 mm Hg with ≥25% IOP reduction; and (D) IOP ≤12 mm Hg with ≥30% IOP reduction from baseline. Kaplan-Meier analysis was used to estimate success rates according to the criteria above, and multivariable Cox models were used to identified risk factors for failure according to criterion A.
Success rates varied based on different criteria, ranging from 43.3% to 62.5% (overall success for criteria D and A, respectively) and from 35.3% to 44.4% (complete success for criteria D and A, respectively) at 1-year follow-up. Higher intraoperative MMC concentration was associated with reduced risk of failure to maintain complete (0.4 vs 0.2 mg/mL: hazard ratio [HR] = 0.441, P < .001) and overall (0.4 vs 0.2 mg/mL: HR = 0.360, P = .004) success. For complete success, other risk factors for failure were pseudoexfoliation glaucoma/pigmentary glaucoma (HR = 1.641, P = .004), primary angle closure glaucoma (HR = 1.611, P < .001), and previous non-glaucomatous ocular surgeries (HR = 2.301, P = .002). For overall success, other risk factors for failure were lower preoperative IOP (for 1-mm Hg increase, HR = 0.934, P = .005), higher number of preoperative antiglaucoma agents (HR = 1.626, P < .001), and Microshunt combined with cataract surgery (HR = 1.526, P = .033).
This study identified risk factors for Microshunt failure, highlighting the importance of high intraoperative MMC dose and careful patient selection to optimize surgical success.
评估青光眼患者中 Microshunt 失败的风险因素。
多中心回顾性队列研究。
该研究纳入了 220 例（220 只眼）在 6 个青光眼单位接受 Microshunt 植入的青光眼连续患者。定义了 4 个眼压（IOP）成功标准：（A）IOP≤21mmHg，IOP 降低≥20%；（B）IOP≤18mmHg，IOP 降低≥20%；（C）IOP≤15mmHg，IOP 降低≥25%；（D）IOP≤12mmHg，IOP 降低≥30%。采用 Kaplan-Meier 分析根据上述标准估计成功率，并采用多变量 Cox 模型根据标准 A 确定失败的风险因素。
根据不同的标准，成功率有所不同，在 1 年随访时，成功率范围为 43.3%至 62.5%（标准 D 和 A 的总成功率）和 35.3%至 44.4%（标准 D 和 A 的完全成功率）。术中 MMC 浓度较高与维持完全（0.4 与 0.2mg/mL：风险比[HR] = 0.441，P<.001）和总体（0.4 与 0.2mg/mL：HR = 0.360，P =.004）成功的失败风险降低有关。对于完全成功，失败的其他风险因素为假性剥脱性青光眼/色素性青光眼（HR = 1.641，P =.004）、原发性闭角型青光眼（HR = 1.611，P<.001）和既往非青光眼眼部手术（HR = 2.301，P =.002）。对于总体成功，失败的其他风险因素为术前眼压较低（增加 1mmHg，HR = 0.934，P =.005）、术前抗青光眼药物数量较高（HR = 1.626，P<.001）和 Microshunt 联合白内障手术（HR = 1.526，P =.033）。
本研究确定了 Microshunt 失败的风险因素，强调了术中使用高剂量 MMC 和仔细选择患者以优化手术成功率的重要性。
