Hougaard Jesper L, Bengtsson Boel
Department of Clinical Sciences in Malmö, Ophthalmology, Lund University, Malmö, Sweden.
Department of Ophthalmology, Skåne University Hospital, Malmö, Sweden.
BMC Ophthalmol. 2025 Mar 11;25(1):120. doi: 10.1186/s12886-025-03925-z.
To survey the monitoring of patients who underwent glaucoma surgery with the purpose of identifying routines possibly delaying the referral process.
We conducted an observational retrospective study of the 2-year period prior to referral of a cohort of patients who underwent trabeculectomy or Xen® Gel Stent implantation at Skåne University Hospital (SUS), Sweden. Data were retrieved from medical records; variables of particular interest were related to intraocular pressure (IOP) measurements and visual field (VF) tests.
Out of 330 patients who underwent surgery, 139 were included. There were 20 referring clinics in total; SUS and two clinics in private practice accounted for 55.4% of all referrals. Prior to referral, the most common number of VF tests per patient was three, and 43.2% (60/139) had ≥ 10 IOP measurements. According to the last VF test, 51.1% had lost > 50% of a full VF. During the 2-year period, 21.9% (28/128 with ≥ 2 VF tests) progressed from ≥ 50% to < 50% remaining of a full VF. The median rate of progression of VF damage was -6.8%/year in the 107 patients who had ≥ 3 VFs, and 67.3% (72/107) were projected, by extrapolation of the linear trend, to lose > 50% of a full VF if the referral had been postponed for 2 years. At the time of the last IOP measurement prior to referral, 84% (117/139) of the patients were on ≥ 3 IOP-lowering agents, and the IOP ranged from 11-45 mmHg, with a median of 20 mmHg.
In general, in the 2-year period prior to referral for surgery, the number of IOP measurements was high, and the number of VF examinations seemed acceptable in most cases. Nevertheless, > 50% had advanced to severe VF loss and fast progression prior to referral. The IOP level is a known risk factor for disease progression that should be monitored at least by VF tests, but the frequent IOP measurements observed in our study, probably due to treatment changes, may have delayed the time to referral.
调查青光眼手术患者的监测情况，以确定可能延迟转诊流程的常规做法。
我们对瑞典斯科讷大学医院（SUS）接受小梁切除术或Xen®凝胶支架植入术的一组患者转诊前的两年时间进行了观察性回顾性研究。数据从医疗记录中获取；特别感兴趣的变量与眼压（IOP）测量和视野（VF）测试有关。
在接受手术的330例患者中，139例被纳入研究。共有20个转诊诊所；SUS和两家私人诊所占所有转诊的55.4%。转诊前，每位患者最常见的视野测试次数为3次，43.2%（60/139）的患者眼压测量次数≥10次。根据最后一次视野测试，51.1%的患者全视野丧失>50%。在两年期间，21.9%（28/128例有≥2次视野测试）的患者全视野剩余比例从≥50%进展至<50%。在有≥3次视野检查的107例患者中，视野损害的中位进展率为-6.8%/年，通过线性趋势外推，67.3%（72/107）的患者如果转诊推迟2年，预计将丧失>50%的全视野。在转诊前最后一次眼压测量时，84%（117/139）的患者使用了≥3种降眼压药物，眼压范围为11-45 mmHg，中位数为20 mmHg。
总体而言，在转诊手术前的两年期间，眼压测量次数较多，大多数情况下视野检查次数似乎可以接受。然而，>50%的患者在转诊前已进展为严重的视野丧失且进展迅速。眼压水平是疾病进展的已知危险因素，至少应通过视野测试进行监测，但我们研究中观察到的频繁眼压测量可能由于治疗调整，可能延迟了转诊时间。
