Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Ophthalmol Glaucoma. 2024 May-Jun;7(3):260-270. doi: 10.1016/j.ogla.2024.01.002. Epub 2024 Jan 22.
PURPOSE: To compare glaucoma tube outcomes of wet age-related macular degeneration (AMD) eyes receiving anti-VEGF injections versus dry AMD eyes and no anti-VEGF. DESIGN: Retrospective clinical cohort study. PARTICIPANTS: Patients with wet AMD and a history of anti-VEGF within a year prior or after stand-alone glaucoma tube surgery and eyes with dry AMD and no history of anti-VEGF with at least 6 months of follow-up. Eyes with neovascular glaucoma or anti-VEGF for reason other than wet AMD were excluded. METHODS: A Kaplan-Meier analysis compared survival for wet versus dry AMD eyes. Failure was defined as intraocular pressure (IOP) > 21 mmHg or < 20% IOP reduction from baseline or IOP ≤ 5 mmHg for 2 consecutive postoperative visits starting at month 3, additional glaucoma surgery, or no light perception. Complete success was defined as no failure or medications at final follow-up. Hypertensive phase was defined for valved tubes as IOP > 21 mmHg within 3 months of surgery after a reduction to < 22 mmHg during the first postoperative week. Intraocular pressure, percent reduction in IOP, number of glaucoma medications, and early (< 1 year) and late (> 1 year) complications were compared through 5 years. MAIN OUTCOME MEASURES: Survival analysis, IOP, number of medications. RESULTS: Baseline IOP, number of medications, or tube type were not significantly different between wet (n = 24) and dry AMD eyes (n = 54). No wet AMD eyes failed versus 10 (18%) dry AMD eyes (P = 0.03). Five-year survival was estimated as 100% for wet AMD and 72% for dry AMD (P = 0.04). Wet AMD eyes had lower IOP (10.6 vs. 12.7 mmHg, P = 0.05), greater IOP reduction (60% vs. 49%, P = 0.04), fewer medications (1.2 vs. 2.1, P = 0.02), and more complete success (50% vs. 15%, P = 0.001) at final follow-up (32 vs. 36 months, P = 0.42). Fewer wet than dry AMD eyes experienced hypertensive phase (0/10 [0%] vs. 4/10 [40%], P = 0.04). There were no significant differences in early or late complications. CONCLUSIONS: Exposure to anti-VEGF may influence postoperative wound healing and capsule formation which may improve glaucoma tube surgical outcomes. Prospective data is needed to consider perioperative administration of anti-VEGF for glaucoma tube surgery. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的：比较湿性年龄相关性黄斑变性（AMD）接受抗血管内皮生长因子（VEGF）注射治疗的眼与干性 AMD 眼以及未接受抗 VEGF 治疗的眼行单纯青光眼引流管手术后的结果。 设计：回顾性临床队列研究。 参与者：在单纯青光眼引流管手术后的 1 年内或之后有湿性 AMD 病史且接受过抗 VEGF 治疗的患者，以及至少有 6 个月随访且有干性 AMD 病史且未接受过抗 VEGF 治疗的患者。患有新生血管性青光眼或因湿性 AMD 以外的其他原因接受抗 VEGF 治疗的患者被排除在外。 方法：采用 Kaplan-Meier 分析比较湿性 AMD 眼与干性 AMD 眼的生存情况。失败定义为：眼压（IOP）>21mmHg 或与基线相比 IOP 降低<20%，或在术后第 3 个月开始的连续 2 次随访中 IOP≤5mmHg，需要进行额外的青光眼手术，或无光感。完全成功定义为最后随访时无失败或无需药物治疗。瓣膜管的高血压期定义为术后 3 个月内 IOP>21mmHg，尽管在术后第 1 周内 IOP 已降至<22mmHg。通过 5 年的随访比较 IOP、IOP 降低百分比、青光眼药物使用数量以及早期（<1 年）和晚期（>1 年）并发症。 主要观察指标：生存分析、IOP、药物使用数量。 结果：湿性 AMD 眼（n=24）与干性 AMD 眼（n=54）之间的基线 IOP、药物使用数量或引流管类型无显著差异。湿性 AMD 眼无一例失败（0/24），而干性 AMD 眼有 10 例（18%）失败（P=0.03）。湿性 AMD 眼的 5 年生存率估计为 100%，干性 AMD 眼为 72%（P=0.04）。湿性 AMD 眼的 IOP 更低（10.6 与 12.7mmHg，P=0.05），IOP 降低幅度更大（60%与 49%，P=0.04），药物使用数量更少（1.2 与 2.1，P=0.02），最后随访时完全成功的比例更高（50%与 15%，P=0.001）（32 与 36 个月，P=0.42）。湿性 AMD 眼发生高血压期的比例（0/10[0%]）低于干性 AMD 眼（4/10[40%]）（P=0.04）。两组早期或晚期并发症无显著差异。 结论：抗 VEGF 的暴露可能会影响术后伤口愈合和囊袋形成，从而改善青光眼引流管手术的结果。需要前瞻性数据来考虑在青光眼引流管手术中应用抗 VEGF 进行围手术期治疗。 金融披露：本文末尾的脚注和披露中可能包含专有的或商业性质的披露信息。
Ophthalmol Glaucoma. 2024
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