Yoshida Yuto, Harano Akiko, Miki Takako, Naito Tomoko, Ichioka Sho, Murakami Kana, Iida Mizuki, Tanito Masaki
Department of Ophthalmology, Shimane University Faculty of Medicine, Shimane, Japan.
Department of Ophthalmology, Juntendo University School of Medicine, Tokyo, Japan.
Graefes Arch Clin Exp Ophthalmol. 2025 Sep 6. doi: 10.1007/s00417-025-06959-7.
To evaluate the impact of prostaglandin-associated periorbitopathy (PAP) severity on the surgical outcomes of trabeculectomy (LEC) and Ahmed Glaucoma Valve (AGV) implantation in patients with primary open-angle glaucoma.
In this propensity score-matched retrospective cohort study, a total of 106 eyes with uncontrolled glaucoma were included. Postoperative follow-ups were conducted at 1, 3, 6, 9, and 12 months. The severity of PAP was evaluated using the Shimane University PAP (SU-PAP) Grading System, with low severity categorized as a score of 0-1 and high severity as a score of 2-3. The primary outcome was surgical success, defined as either complete success (IOP ≤ 18, ≤15, or ≤ 12 mmHg with ≥ 20% reduction from baseline without medications) or qualified success (same criteria with medications). A Cox proportional hazard model was used to assess the risk of surgical failure for surgical success, with stratification based on PAP severity.
In low PAP severity, AGV group demonstrated a significantly higher risk of surgical failure compared to LEC group across all target IOP levels (complete success: HR (95% CI), 3.92 (1.89, 8.15) for IOP ≤ 12, 4.33 (2.04, 9.20) for IOP ≤ 15, and 4.50 (2.06, 9.83) for IOP ≤ 18; qualified success: HR (95% CI), 3.37 (1.48, 7.69) for IOP ≤ 12, 3.78 (1.73, 8.24) for IOP ≤ 15, and 4.28 (2.02, 9.05) for IOP ≤ 18). In contrast, there was no significant difference in surgical failure between LEC and AGV in higher PAP severity.
PAP severity should be considered when selecting a surgical approach for glaucoma.
WHAT IS KNOWN : Prostaglandin-associated periorbitopathy (PAP) is a common side effect of prostaglandin analogs and may affect intraocular pressure control and surgical outcomes.
This is the first study comparing trabeculectomy (LEC) and Ahmed Glaucoma Valve (AGV) outcomes stratified by PAP severity In patients with low PAP severity, LEC showed significantly higher surgical success than AGV. No significant difference was found between LEC and AGV in patients with high PAP severity.
评估前列腺素相关性眶周病变（PAP）严重程度对原发性开角型青光眼患者小梁切除术（LEC）和艾哈迈德青光眼引流阀（AGV）植入术手术效果的影响。
在这项倾向评分匹配的回顾性队列研究中，共纳入106只未控制的青光眼患眼。术后分别在1、3、6、9和12个月进行随访。使用岛根大学PAP（SU-PAP）分级系统评估PAP的严重程度，低严重程度定义为评分为0-1分，高严重程度定义为评分为2-3分。主要结局为手术成功，定义为完全成功（眼压≤18、≤15或≤12 mmHg，且未使用药物情况下较基线降低≥20%）或合格成功（使用药物情况下符合相同标准）。采用Cox比例风险模型评估手术成功的手术失败风险，并根据PAP严重程度进行分层。
在PAP严重程度较低时，在所有目标眼压水平下，AGV组与LEC组相比手术失败风险显著更高（完全成功：眼压≤12时，风险比（95%置信区间）为3.92（1.89，8.15）；眼压≤15时，为4.33（2.04，9.20）；眼压≤18时，为4.50（2.06，9.83）；合格成功：眼压≤12时，风险比（95%置信区间）为3.37（1.48，7.69）；眼压≤15时，为3.78（1.73，8.24）；眼压≤18时，为4.28（2.02，9.05））。相比之下，在PAP严重程度较高时，LEC和AGV在手术失败方面无显著差异。
选择青光眼手术方式时应考虑PAP严重程度。
已知内容：前列腺素相关性眶周病变（PAP）是前列腺素类似物的常见副作用，可能影响眼压控制和手术效果。
这是第一项按PAP严重程度分层比较小梁切除术（LEC）和艾哈迈德青光眼引流阀（AGV）效果的研究。在PAP严重程度较低的患者中，LEC的手术成功率显著高于AGV。在PAP严重程度较高的患者中，LEC和AGV之间未发现显著差异。
