Threetong Thanatporn, Yongsiri Somchai, Annopawong Kornkamol
Department of Ophthalmology, Faculty of Medicine, Burapha University, Chonburi, Thailand.
Department of Medicine, Faculty of Medicine, Burapha University, Chonburi, Thailand.
Clin Ophthalmol. 2024 Nov 1;18:3111-3123. doi: 10.2147/OPTH.S485331. eCollection 2024.
To evaluate the surgical outcomes and identify ocular and systemic prognostic factors of trabeculectomy with mitomycin C (MMC) in the eyes of patients with neovascular glaucoma (NVG) in Thailand.
This retrospective study was conducted by reviewing records of Thai patients with NVG who underwent trabeculectomy with MMC between 2013 and 2022. Criterion failure was defined as intraocular pressure (IOP) >21 mmHg or less than a 20% reduction below baseline on two consecutive study visits after 3 months, IOP ≤5 mmHg on two consecutive study visits after 3 months, reoperation for glaucoma, and loss of light perception. Kaplan-Meier survival curves were used to examine success rates, and risk factors were analyzed using Cox's proportional hazard model.
The study included 106 eyes of 106 patients with a mean age of 57 years (range, 27-87 years). The cause of NVG was proliferative diabetic retinopathy (PDR) in 63 eyes (59.43%), central retinal vein occlusion (CRVO) in 39 eyes (36.79%), and ocular ischemic syndrome (OIS) in 4 eyes (3.77%). The cumulative probability of success in the first year was 73.6% with anti-glaucoma medication and 54.7% without medication. The multivariate model demonstrated that major cardiovascular events (hazard ratio [HR], 2.778 p=0.001) and preoperative systemic antiglaucoma medication use (HR, 1.837, p=0.045) were prognostic factors for surgical failure among all NVG patients. Postoperative manipulation with a subconjunctival injection of MMC occurred significantly more frequently in the failure group (HR, 3.100; p<0.001).
Trabeculectomy with MMC effectively reduced the elevated IOP associated with NVG in Thailand. Underlying systemic diseases involving major vascular events and the use of adjunct systemic IOP-lowering medications were prognostic factors for surgical failure.
评估在泰国新生血管性青光眼（NVG）患者眼中使用丝裂霉素C（MMC）进行小梁切除术的手术效果，并确定眼部和全身的预后因素。
本回顾性研究通过查阅2013年至2022年间接受MMC小梁切除术的泰国NVG患者的记录进行。标准失败定义为眼压（IOP）>21 mmHg，或在3个月后的两次连续研究访视中眼压较基线降低不足20%，在3个月后的两次连续研究访视中眼压≤5 mmHg，因青光眼再次手术，以及光感丧失。采用Kaplan-Meier生存曲线检查成功率，并使用Cox比例风险模型分析危险因素。
该研究纳入了106例患者的106只眼，平均年龄57岁（范围27 - 87岁）。NVG的病因是增殖性糖尿病视网膜病变（PDR）63只眼（59.43%），视网膜中央静脉阻塞（CRVO）39只眼（36.79%），眼部缺血综合征（OIS）4只眼（3.77%）。使用抗青光眼药物时第一年成功的累积概率为73.6%，未使用药物时为54.7%。多变量模型表明，主要心血管事件（风险比[HR]，2.778，p = 0.001）和术前全身使用抗青光眼药物（HR，1.837，p = 0.045）是所有NVG患者手术失败的预后因素。失败组结膜下注射MMC进行术后操作的情况明显更频繁（HR，3.100；p < 0.001）。
在泰国，使用MMC进行小梁切除术有效降低了与NVG相关的眼压升高。涉及主要血管事件的潜在全身性疾病以及辅助性全身降眼压药物的使用是手术失败的预后因素。
