Fiore Carlo, Shang Xiao, Lincke Joel-Benjamin, Häner Nathanael Urs, Zinkernagel Martin Sebastian, Unterlauft Jan Darius
Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
Graduate School for Cellular and Biomedical Sciences, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.
J Clin Med. 2024 Dec 6;13(23):7434. doi: 10.3390/jcm13237434.
: This study aimed to investigate the five-year outcomes of deep sclerectomy (DS) in patients with pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG). : This retrospective, observational, unicentric study analyzed POAG and PEXG patients. Intraocular pressure (IOP), the number of IOP-lowering medications, peripapillary retinal nerve fiber layer (RNFL) thickness, the number of postoperative interventions, surgical success rates, and secondary surgery rates were evaluated at baseline and during follow-up appointments. : A total of 109 POAG and 153 PEXG eyes were included. Over the 5-year follow-up, IOP decreased in both groups ( = 0.17), from 22.8 ± 0.7 to 13.3 ± 0.6 mmHg ( < 0.001; POAG) and from 24.3 ± 0.8 to 16.6 ± 1.2 mmHg ( < 0.001; PEXG). The number of IOP-lowering medications decreased comparably ( = 0.99), from 3.1 ± 0.1 to 1.7 ± 0.3 ( = 0.001; POAG) and from 3.4 ± 0.1 to 1.7 ± 0.2 ( < 0.001; PEXG). Peripapillary RNFL thickness decreased in both groups ( = 0.31), from 60.6 ± 1.9 to 54.2 ± 2.4 µm ( < 0.001; POAG) and from 63.1 ± 1.7 to 58.0 ± 2.3 µm ( < 0.001; PEXG). The 5-year complete success rates were 33% and 12% for the POAG and PEXG groups, respectively ( = 0.01). The qualified success rates were 63% and 40% ( = 0.03). Secondary glaucoma surgery was required in 8% of POAG eyes and 21% of PEXG eyes ( = 0.04). : DS resulted in comparable results for IOP, medications, and RNFL development in the PEXG and POAG groups but in less favorable outcomes concerning surgical success and further necessary repeated glaucoma surgery in patients with PEXG over the 5-year follow-up period.
本研究旨在调查剥脱性青光眼（PEXG）和原发性开角型青光眼（POAG）患者行深层巩膜切除术（DS）的五年预后。本项回顾性、观察性、单中心研究分析了POAG和PEXG患者。在基线和随访期间评估眼压（IOP）、降低眼压药物的数量、视乳头周围视网膜神经纤维层（RNFL）厚度、术后干预次数、手术成功率和二次手术率。共纳入109只POAG眼和153只PEXG眼。在5年的随访中，两组眼压均下降（P = 0.17），POAG组从22.8±0.7 mmHg降至13.3±0.6 mmHg（P < 0.001），PEXG组从24.3±0.8 mmHg降至16.6±1.2 mmHg（P < 0.001）。降低眼压药物的数量也有类似下降（P = 0.99），POAG组从3.1±0.1降至1.7±0.3（P = 0.001），PEXG组从3.4±0.1降至1.7±0.2（P < 0.001）。两组视乳头周围RNFL厚度均下降（P = 0.31），POAG组从60.6±1.9 µm降至54.2±2.4 µm（P < 0.001），PEXG组从63.1±1.7 µm降至58.0±2.3 µm（P < 0.001）。POAG组和PEXG组的5年完全成功率分别为33%和12%（P = 0.01）。合格成功率分别为63%和40%（P = 0.03）。8%的POAG眼和21%的PEXG眼需要行继发性青光眼手术（P = 0.04）。DS在PEXG组和POAG组的IOP、药物使用和RNFL进展方面产生了类似的结果，但在5年随访期内，PEXG患者的手术成功率和进一步必要的重复青光眼手术方面的预后较差。
