Department of Ophthalmology, University Hospital Maggiore della Carita', Novara, Italy; Department of Health Sciences, Università del Piemonte Orientale "A. Avogadro", Novara, Italy.
Department of Surgical Sciences, University Eye Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Ophthalmology. 2024 Jul;131(7):803-814. doi: 10.1016/j.ophtha.2024.01.008. Epub 2024 Jan 8.
Review hypotony failure criteria used in glaucoma surgical outcome studies and evaluate their impact on success rates.
Systematic literature review and application of hypotony failure criteria to 2 retrospective cohorts.
A total of 934 eyes and 1765 eyes undergoing trabeculectomy and deep sclerectomy (DS) with a median follow-up of 41.4 and 45.4 months, respectively.
Literature-based hypotony failure criteria were applied to patient cohorts. Intraocular pressure (IOP)-related success was defined as follows: (A) IOP ≤ 21 mmHg with ≥ 20% IOP reduction; (B) IOP ≤ 18 mmHg with ≥ 20% reduction; (C) IOP ≤ 15 mmHg with ≥ 25% reduction; and (D) IOP ≤ 12 mmHg with ≥ 30% reduction. Failure was defined as IOP exceeding these criteria in 2 consecutive visits > 3 months after surgery, loss of light perception, additional IOP-lowering surgery, or hypotony. Cox regression estimated failure risk for different hypotony criteria, using no hypotony as a reference. Analyses were conducted for each criterion and hypotony type (i.e., numerical [IOP threshold], clinical [clinical manifestations], and mixed [combination of numerical or clinical criteria]).
Hazard ratio (HR) for failure risk.
Of 2503 studies found, 278 were eligible, with 99 studies (35.6%) lacking hypotony failure criteria. Numerical hypotony was predominant (157 studies [56.5%]). Few studies used clinical hypotony (3 isolated [1.1%]; 19 combined with low IOP [6.8%]). Forty-nine different criteria were found, with IOP < 6 mmHg, IOP < 6 mmHg on ≥ 2 consecutive visits after 3 months, and IOP < 5 mmHg being the most common (41 [14.7%], 38 [13.7%], and 13 [4.7%] studies, respectively). In both cohorts, numerical hypotony posed the highest risk of failure (HR, 1.51-1.21 for criteria A to D; P < 0.001), followed by mixed hypotony (HR, 1.41-1.20 for criteria A to D; P < 0.001), and clinical hypotony (HR, 1.12-1.04; P < 0.001). Failure risk varied greatly with various hypotony definitions, with the HR ranging from 1.02 to 10.79 for trabeculectomy and 1.00 to 8.36 for DS.
Hypotony failure criteria are highly heterogenous in the glaucoma literature, with few studies focusing on clinical manifestations. Numerical hypotony yields higher failure rates than clinical hypotony and can underestimate glaucoma surgery success rates. Standardizing failure criteria with an emphasis on clinically relevant hypotony manifestations is needed.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
回顾青光眼手术结果研究中使用的低眼压失败标准，并评估其对成功率的影响。
系统文献回顾和将低眼压失败标准应用于 2 个回顾性队列。
共纳入 934 只眼和 1765 只眼，分别接受小梁切除术和深层巩膜切除术，中位随访时间分别为 41.4 个月和 45.4 个月。
根据文献中的低眼压失败标准对患者队列进行评估。眼压（IOP）相关的成功定义如下：（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%。失败定义为术后连续 2 次就诊，IOP 超过上述标准且间隔≥3 个月，或出现光感丧失、需要额外的眼压降低手术或低眼压。使用无低眼压作为参考，Cox 回归估计不同低眼压标准的失败风险。对每种标准和低眼压类型（即数值 [IOP 阈值]、临床 [临床表现] 和混合 [数值或临床标准的组合]）进行分析。
失败风险的危险比（HR）。
在 2503 项研究中，有 278 项符合纳入标准，其中 99 项研究（35.6%）缺乏低眼压失败标准。数值性低眼压占主导地位（157 项研究[56.5%]）。很少有研究使用临床性低眼压（3 项孤立的研究[1.1%]；19 项与低眼压联合的研究[6.8%]）。共发现 49 种不同的标准，其中 IOP<6mmHg、术后 3 个月后连续 2 次就诊时 IOP<6mmHg 和 IOP<5mmHg 的研究最为常见（分别有 41 项[14.7%]、38 项[13.7%]和 13 项[4.7%]）。在两个队列中，数值性低眼压的失败风险最高（HR 为 A 至 D 标准的 1.51-1.21；P<0.001），其次是混合性低眼压（HR 为 A 至 D 标准的 1.41-1.20；P<0.001），最后是临床性低眼压（HR 为 1.12-1.04；P<0.001）。各种低眼压定义的失败风险差异很大，对于小梁切除术，HR 范围为 1.02 至 10.79，对于深层巩膜切除术，HR 范围为 1.00 至 8.36。
在青光眼文献中，低眼压失败标准高度异质，很少有研究关注临床表现。数值性低眼压的失败率高于临床性低眼压，可能会低估青光眼手术的成功率。需要标准化失败标准，并强调与临床相关的低眼压表现。
参考文献后可能会有专有或商业披露。
