Iwasaki Kentaro, Kojima Sachi, Wajima Ryotaro, Matsuda Akira, Yoshida Koki, Tsutsui Aika, Kono Michihiro, Nozaki Miho, Namiguchi Koji, Nitta Keisuke, Miura Yusaku, Inoue Toshihiro, Higashide Tomomi, Ishida Kyoko, Tanito Masaki, Inatani Masaru
Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji, Yoshida, Fukui, 910-1193, Japan.
Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
Adv Ther. 2025 Apr;42(4):1745-1759. doi: 10.1007/s12325-025-03128-4. Epub 2025 Feb 17.
This multicenter retrospective study compared the surgical outcomes of Baerveldt glaucoma implant (BGI) surgery with those of Ahmed glaucoma valve (AGV) surgery in patients with neovascular glaucoma (NVG).
The study included patients with NVG aged ≥ 20 years who had undergone BGI (223 eyes) or AGV (146 eyes) surgery between April 1, 2012 and December 31, 2021 across 10 clinical centers in Japan. Surgical success or failure was the primary outcome measure of this study. We defined surgical failure as a reduction of < 20% in the pre-operative intraocular pressure (IOP) or criterion A (IOP > 21 mmHg), criterion B (IOP > 17 mmHg), or criterion C (IOP > 14 mmHg). In addition, we considered a requirement for re-operation, loss of light perception, and hypotony as surgical failure.
The surgical success rate of the BGI surgery group was significantly higher than that of the AGV group for criteria A (P = 0.01) and B (P = 0.01). Multivariate analysis revealed that AGV surgery showed significant associations with surgical failure for criteria A (hazard ratio, 1.74), B (hazard ratio, 1.72), and C (hazard ratio, 1.34). The overall incidence of postoperative complications was comparable between the two groups. The requirement for re-operation in the AGV surgery group was significantly higher than that in the BGI surgery group (12.3% vs. 5.8%, P = 0.03).
BGI surgery yielded a higher success rate than AGV surgery in patients with NVG for a target IOP of < 21 or < 17 mmHg. No significant differences were observed between the two procedures in terms of the incidence of postoperative complications. Additional glaucoma surgery was required more frequently following AGV surgery. Therefore, BGI surgery may be a more suitable and efficacious option for the management of IOP in patients with neovascular glaucoma compared with AGV surgery.
这项多中心回顾性研究比较了在新生血管性青光眼（NVG）患者中，Baerveldt青光眼植入物（BGI）手术与Ahmed青光眼阀（AGV）手术的手术效果。
该研究纳入了年龄≥20岁、于2012年4月1日至2021年12月31日期间在日本10个临床中心接受BGI手术（223眼）或AGV手术（146眼）的NVG患者。手术成功或失败是本研究的主要结局指标。我们将手术失败定义为术前眼压（IOP）降低<20%或符合标准A（IOP>21 mmHg）、标准B（IOP>17 mmHg）或标准C（IOP>14 mmHg）。此外，我们将再次手术的需求、光感丧失和低眼压视为手术失败。
对于标准A（P = 0.01）和标准B（P = 0.01），BGI手术组的手术成功率显著高于AGV组。多因素分析显示，AGV手术与标准A（风险比，1.74）、标准B（风险比，1.72）和标准C（风险比，1.34）的手术失败显著相关。两组术后并发症的总体发生率相当。AGV手术组再次手术的需求显著高于BGI手术组（12.3%对5.8%，P = 0.03）。
对于目标眼压<21或<17 mmHg的NVG患者，BGI手术的成功率高于AGV手术。两种手术在术后并发症发生率方面未观察到显著差异。AGV手术后需要更频繁地进行额外的青光眼手术。因此，与AGV手术相比，BGI手术可能是治疗新生血管性青光眼患者眼压更合适、更有效的选择。
