Mamidipaka Anusha, Shi Amy, Addis Victoria, He Jocelyn, Lee Roy, Di Rosa Isabel, Salowe Rebecca, Ying Gui-Shuang, O'Brien Joan
Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania.
Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
J Glaucoma. 2025 Feb 1;34(2):127-135. doi: 10.1097/IJG.0000000000002503. Epub 2024 Oct 2.
Trabeculectomy in African ancestry individuals with primary open angle glaucoma (POAG) shows a 46% success rate and frequent complications, indicating that younger age and family history are significant predictors of surgical failure in this high-risk population.
To investigate outcomes of trabeculectomy ab externo in African ancestry POAG patients and to analyze the impact of demographic and phenotypic factors on surgical success and complication rates.
A retrospective case-control study enrolled 63 eyes of 55 POAG cases who underwent trabeculectomy ab externo. Data on demographics, family glaucoma history, surgical specifics, and pre/postoperative measures (intraocular pressure, visual acuity, visual field, medication usage, complications within 1 year) were collected. The analysis included linear/logistic regression models adjusting for inter-eye correlation.
Trabeculectomy yielded success without additional medication in 46%, qualified success with medication in 22%, and surgical failure necessitating further intervention in 32% within 1 year. Subjects experienced a reduction in intraocular pressure (IOP) (46%), daily glaucoma medication (73%), and eye drop usage (67%) 1-year post-trabeculectomy (all P <0.001). However, there was a postoperative decline of 56% in visual acuity (VA) ( P <0.001) and a significant worsening of visual field parameters, including a 14% decrease in mean deviation ( P =0.02) and a 19% decrease in visual field index ( P =0.004). Fifty-nine percent of patient eyes experienced complications within 1 year of surgery. Univariate analysis of predictive factors for surgical outcomes revealed that younger age at surgery ( P =0.01) and family history of glaucoma ( P =0.046) were predictive of lower rates of surgical success. Multivariable analysis revealed worse preoperative VA (OR: 0.79 per 0.1 LogMAR increases, P =0.02) was associated with a lower likelihood of surgical success.
This study underscores the low rates of trabeculectomy success and high rates of complications in an African ancestry population with POAG. While the procedure exhibited positive effects on IOP control and medication reduction, our analysis found that multiple factors, particularly age, family history, and worse preoperative VA play crucial roles in influencing surgical success.
在患有原发性开角型青光眼（POAG）的非洲裔个体中，小梁切除术的成功率为46%，且并发症频发，这表明在这个高风险人群中，较年轻的年龄和家族史是手术失败的重要预测因素。
研究非洲裔POAG患者外路小梁切除术的疗效，并分析人口统计学和表型因素对手术成功率和并发症发生率的影响。
一项回顾性病例对照研究纳入了55例接受外路小梁切除术的POAG患者的63只眼睛。收集了有关人口统计学、青光眼家族史、手术细节以及术前/术后测量数据（眼压、视力、视野、用药情况、1年内的并发症）。分析包括调整眼间相关性的线性/逻辑回归模型。
小梁切除术在1年内使46%的患者无需额外用药即获得成功，22%的患者用药后达到合格成功，32%的患者手术失败需要进一步干预。小梁切除术后1年，患者的眼压（IOP）降低了46%，每日青光眼用药量降低了73%，眼药水使用量降低了67%（所有P<0.001）。然而，术后视力（VA）下降了56%（P<0.001），视野参数显著恶化，包括平均偏差降低了14%（P =0.02），视野指数降低了19%（P =0.004）。59%的患者眼睛在手术后1年内出现并发症。对手术结果预测因素的单因素分析显示手术时年龄较小（P =0.01）和青光眼家族史（P =0.046）可预测较低的手术成功率。多变量分析显示术前视力较差（每增加0.1 LogMAR，OR：0.79，P =0.02）与较低的手术成功可能性相关。
本研究强调了在患有POAG的非洲裔人群中小梁切除术成功率低且并发症发生率高。虽然该手术对眼压控制和用药减少有积极作用，但我们的分析发现多个因素，特别是年龄、家族史和术前较差的视力在影响手术成功方面起着关键作用。
