Ophthalmology Clinic, Department of Medicine and Aging Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy.
Ophthalmology Unit, Department of Surgery, Medicine, Molecular and Emergency, University of Pisa, Pisa, Italy.
Graefes Arch Clin Exp Ophthalmol. 2024 Jul;262(7):2039-2056. doi: 10.1007/s00417-023-06333-5. Epub 2023 Dec 13.
Ocular surface (OS) disorders before glaucoma filtration surgery (GFS) have been considered to play a crucial role influencing the surgical outcome. Conversely, the impact of surgery itself on the OS is almost completely overlooked, though evidence suggest that ocular surface disease (OSD) may be induced in patients by GFS. This review analyzes the determinants involved in the OSD development after GFS, the clinical features and related consequences, the main diagnostic hallmarks, as well as the therapeutic strategies for its management.
The PubMed database was utilized for the literature examination. Keywords that were searched included ocular surface disease, glaucoma filtration surgery, filtration bleb, post-surgical management, and quality of life.
After GFS, OSD is promoted by peri- and post-operative factors, such as the filtration bleb (FB) development, combined surgical approach with phacoemulsification, the use of antifibrotic agents and the reintroduction of antiglaucoma medications. This particular form of OSD that present similar clinical features to mild to moderate dry eye, can be named as post-glaucoma surgery-OSD (PGS-OSD). PGS-OSD may negatively affect the FB functionality, thus potentially hindering the disease control, and significantly worsen the patient quality of life (QOL).
Clinicians are encouraged to routinely include the OS evaluation after GFS and to consider proper management when the occurrence of PGS-OSD worsen the patient's QOL or exert negative effects to the FB functionality. An outline summarizing the main risk factors and the most appropriate therapeutic options to mitigate the PGS-OSD was proposed to support the routine practice.
在青光眼滤过手术（GFS）之前的眼表（OS）疾病被认为对手术结果有重要影响。相反，手术本身对 OS 的影响几乎完全被忽视，尽管有证据表明 GFS 可能会导致患者出现眼表疾病（OSD）。本综述分析了 GFS 后 OSD 发展的决定因素、临床特征和相关后果、主要诊断特征以及管理的治疗策略。
利用 PubMed 数据库进行文献检查。搜索的关键词包括眼表疾病、青光眼滤过手术、滤过泡、术后管理和生活质量。
GFS 后，围手术期和术后因素促进了 OSD 的发展，如滤过泡（FB）的形成、与超声乳化联合的手术方法、抗纤维化药物的使用以及抗青光眼药物的重新引入。这种特殊形式的 OSD 与轻度至中度干眼具有相似的临床特征，可称为青光眼手术后眼表疾病（PGS-OSD）。PGS-OSD 可能会影响 FB 的功能，从而可能影响疾病的控制，并显著降低患者的生活质量（QOL）。
鼓励临床医生在 GFS 后常规评估 OS，并在发生 PGS-OSD 时考虑适当的管理，当 PGS-OSD 恶化患者的 QOL 或对 FB 功能产生负面影响时。提出了一个总结主要危险因素和最适当的治疗选择的概要，以支持常规实践。
