Ophthalmology. Glaucoma最新文献_第10页

Effect of Early Aqueous Suppression After Valved Tube Shunt Surgery for Uveitic Glaucoma 葡萄膜性青光眼阀管分流术后早期水抑制的效果

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-01-01 DOI: 10.1016/j.ogla.2023.08.002

Minjia Tang BA , Nathan P. Gill PhD , Angelo P. Tanna MD

Purpose

To compare outcomes of early aqueous suppression (EAS) and standard therapy (ST) after Ahmed Glaucoma Valve (AGV) implantation for uveitic glaucoma.

Design

Retrospective comparative cohort study.

Participants

All patients with uveitic glaucoma underwent AGV implantation from January 2010 to October 2020 at Northwestern Medicine.

Methods

Excluding the first postoperative day 1 (POD1), only eyes with IOP 10–15 mmHg at their first visit with IOP ≥ 10 mmHg were included in the main analysis. Early aqueous suppression (EAS) was defined as initiation of ocular hypotensive therapy when IOP was first 10–15 mmHg. Standard therapy was initiation of therapy at any later time. Failure was defined as IOP > 21 mmHg, < 5 mmHg, or < 20% reduction in IOP from baseline after 3 months, for 2 consecutive study visits. Hypotony was defined as IOP ≤ 5 mmHg for ≥ 2 visits. Hypertensive phase was defined as IOP > 21 mmHg for 2 consecutive visits in the first 3 months.

Main Outcome Measures

Proportion achieving overall success; incidence of hypotony and hypertensive phase.

Results

Twenty-eight eyes of 26 patients were in the EAS group and 20 eyes of 19 patients were in the ST group, with a mean follow-up of 17.7 and 28.2 months, respectively. Baseline IOP was similar in the EAS (31.2 ± 10.1 mmHg) and ST (34.6 ± 12.2 mmHg) groups; P = 0.18. Final IOP was lower in the EAS group (12.9 ± 4.6 mmHg) than the ST group (16.4 ± 5.7 mmHg; P = 0.02) on 2.6 ± 0.9 medications in the EAS group and 1.8 ± 1.5 in the ST group (P = 0.07). Overall success was achieved in 87% of EAS eyes and 74% of ST eyes (P = 0.43). There were no statistically significant differences in the occurrence of additional glaucoma surgery (4% for EAS, 20% for ST; P = 0.11), hypotony (7% for EAS, 0% for ST; P = 0.50), or hypertensive phase (4% for EAS, 21% for ST; P = 0.09).

Conclusions

EAS was associated with a lower final IOP after AGV in uveitic glaucoma eyes; however, more medications were in use at the final visit. No statistically significant differences in overall success or the incidence of adverse events were observed.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的比较葡萄膜炎性青光眼植入艾哈迈德青光眼瓣膜（AGV）后早期水抑制（EAS）和标准疗法（ST）的疗效。方法排除术后第1天（POD1），仅将首次就诊时眼压为10-15 mmHg且眼压≥10 mmHg的患者纳入主要分析。早期眼压抑制（EAS）是指眼压首次达到 10-15 mmHg 时开始降眼压治疗。标准疗法是在任何时间开始治疗。治疗失败的定义是：连续 2 次检查，3 个月后眼压比基线降低 21 mmHg、5 mmHg 或 20%。低血压期的定义是连续 2 次就诊时眼压≤ 5 mmHg。结果EAS组26名患者中有28只眼睛，ST组19名患者中有20只眼睛，平均随访时间分别为17.7个月和28.2个月。EAS 组（31.2 ± 10.1 mmHg）和 ST 组（34.6 ± 12.2 mmHg）的基线眼压相似；P = 0.18。EAS 组的最终眼压（12.9 ± 4.6 mmHg）低于 ST 组（16.4 ± 5.7 mmHg；P = 0.02），EAS 组用药 2.6 ± 0.9 次，ST 组用药 1.8 ± 1.5 次（P = 0.07）。87%的 EAS 眼睛和 74% 的 ST 眼睛获得了总体成功（P = 0.43）。在发生额外青光眼手术（EAS 组为 4%，ST 组为 20%；P = 0.11）、眼压过低（EAS 组为 7%，ST 组为 0%；P = 0.50）或高血压期（EAS 组为 4%，ST 组为 21%；P = 0.09）方面，差异无统计学意义。在总体成功率或不良事件发生率方面未观察到有统计学意义的差异。

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引用次数: 0

Ocular Oil Odyssey: Hyper-Oleon 眼油奥德赛：Hyper-Oleon.

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2024-01-01 DOI: 10.1016/j.ogla.2023.11.004

Sagarika Snehi DNB, FAICO, Puja Hingorani-Bang MS, Nidhi Mamtani MS

引用次数: 0

Rethinking Prophylactic Laser Peripheral Iridotomy in Primary Angle-Closure Suspects 对原发性闭角可疑患者进行预防性激光周边虹膜切除术的再思考：综述。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2023-11-01 DOI: 10.1016/j.ogla.2023.06.004

Theodoros Filippopoulos MD , John Danias MD, PhD , Efthymios Karmiris MD, PhD , Gordana Sunaric Mégevand MD , Douglas J. Rhee MD , Gus Gazzard MD, FRCOphth , Fotis Topouzis MD, PhD , Benjamin Xu MD, PhD

Purpose

To examine the generalizability, discuss limitations, and critically appraise recommendations on the management of primary angle-closure suspects (PACSs) that emerged as a result of recent randomized clinical trials challenging the widely accepted clinical practice of offering laser peripheral iridotomy (LPI) to PACS patients. To synthetize findings from these and other studies.

Design

Narrative review.

Subjects

Patients classified as PACS.

Methods

The Zhongshan Angle-Closure Prevention (ZAP)–Trial and the Singapore Asymptomatic Narrow Angle Laser Iridotomy Study (ANA-LIS) along with accompanying publications were reviewed. Epidemiologic studies reporting on the prevalence of primary angle-closure glaucoma and other precursor forms of the disease were also analyzed along with publications reporting on the natural course of the disease or studies reporting on outcomes after prophylactic LPI.

Main Outcome Measures

Incidence of progression to more severe forms of angle closure.

Results

Patients recruited in recent randomized clinical trials are asymptomatic, do not have cataracts, may be younger, and have, on average, deeper anterior chambers depth compared with patients treated with LPI in clinics.

Conclusions

The ZAP-Trial and ANA-LIS clearly represent the best available data on PACS management, additional parameters however may need to be considered when physicians face patients in clinic. PACS patients encountered at tertiary referral centers may represent more advanced cases with respect to ocular biometric parameters and may be at higher risk for disease progression compared with those recruited through population-based screening.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的：检查原发性闭角可疑病例（PACSs）的可推广性，讨论其局限性，并批判性地评价其管理建议，这些建议是最近随机临床试验的结果，这些试验挑战了为PACS患者提供激光周边虹膜切开术（LPI）的广泛接受的临床实践。综合这些研究和其他研究的结果。设计：叙述性评论。受试者：分类为PACS的患者。方法：回顾中山预防闭角（ZAP）试验和新加坡无症状窄角激光虹膜切开术研究（ANA-LIS）以及相关出版物。还分析了报告原发性闭角型青光眼和其他前驱形式疾病患病率的流行病学研究，以及报告疾病自然病程的出版物或报告预防性LPI后结果的研究。主要结果指标：进展为更严重形式的角闭合的发生率。结果：在最近的随机临床试验中招募的患者没有症状，没有白内障，可能更年轻，与临床上接受LPI治疗的患者相比，平均前房深度更深。结论：ZAP试验和ANA-LIS清楚地代表了PACS管理的最佳可用数据，然而，当医生在临床上面对患者时，可能需要考虑其他参数。与通过基于人群的筛查招募的患者相比，在三级转诊中心遇到的PACS患者在眼部生物特征参数方面可能代表更晚期的病例，并且可能具有更高的疾病进展风险。财务披露：可在引用后找到专有或商业披露。

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引用次数: 0

Glaucoma Fellows-in-Training Recent Surgery Trends 青光眼培训人员近期手术趋势。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2023-11-01 DOI: 10.1016/j.ogla.2023.06.006

Grace E. Nipp BS , Ahmad A. Aref MD, MBA , Sandra S. Stinnett DrPH , Kelly W. Muir MD, MHSc

Purpose

The volume of microinvasive glaucoma surgery (MIGS) has increased dramatically in recent years, from 31 059 in 2013 to 69 420 in 2018. We investigated the impact of this trend on trainees by determining the proportion of glaucoma surgeries performed by fellows-in-training comprised by MIGS, trabeculectomies, and aqueous shunts.

Design

Retrospective analysis.

Participants

Fellows-in-training at Glaucoma Fellowship Programs certified by the Association of University Professors of Ophthalmology Fellowship Compliance Committee (AUPO-FCC)

Methods

We analyzed aggregate summaries of surgeries performed by fellows as reported to the AUPO-FCC from the academic years (AYs) beginning in 2014 through AY 2020. Each report lists the average number of procedures performed per surgery type per fellow. We combined these averages to create a sum “average number surgeries performed” across glaucoma surgeries and computed the proportion that each surgery type (MIGS, trabeculectomies, and aqueous shunts) represented within the total average number of surgeries performed per year.

Main Outcome Measures

Average number of procedures performed for each surgery type as well as the proportion that each surgery type (MIGS, trabeculectomies, and aqueous shunts) represented within the total average number of procedures performed per year.

Results

Average number of MIGS performed is significantly greater in later years compared with earlier years (P < 0.001). The average number of trabeculectomies performed between AYs 2014 and AY 2020 ranged from 21.8 to 31.9 and decreased, on average, by − 0.80 year-to-year. The average number of aqueous shunts performed between AY 2014 and AY 2020 ranged from 44.7 to 49.5, with an average increase of + 0.8 year-to-year. The total average number of procedures performed (across all 3 surgical subtypes) increased on average by + 4.8 procedures each year.

Conclusions

Since 2014, fellows are performing increasing numbers of MIGS procedures, whereas the total number of trabeculectomies and aqueous shunt surgeries performed each year remain similar, resulting in a net increase in total number of procedures performed per fellow each year. This suggests the increase in MIGS is not associated with a substantial decline in trabeculectomies or aqueous shunts performed by glaucoma fellows.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的:近年来，微创青光眼手术(MIGS)的数量急剧增加，从2013年的31,059例增加到2018年的69420例。我们调查了这一趋势对受训人员的影响，确定了受训人员进行青光眼手术的比例，包括MIGS、小梁切除术和水分流术。设计:回顾性分析。参与者:由眼科大学教授协会奖学金遵守委员会(AUPO-FCC)认证的青光眼奖学金项目的培训研究员方法:我们分析了从2014年开始到2020年学年(AYs)向AUPO-FCC报告的研究员进行手术的汇总摘要。每份报告都列出了每位医生每种手术类型的平均手术次数。我们将这些平均值结合起来，得出青光眼手术的“平均手术次数”，并计算出每种手术类型(MIGS、小梁切除术和水分流术)在每年手术总平均次数中所占的比例。主要结局指标:每种手术类型的平均手术次数，以及每种手术类型(MIGS、小梁切除术和水分流)在每年总平均手术次数中所占的比例。结果:与早期相比，后期进行的平均MIGS次数显著增加(P < 0.001)。2014年至2020年期间，小梁切除术的平均数量从21.8例到31.9例不等，平均每年减少0.80例。2014年至2020年期间进行的平均水分流次数为44.7至49.5次，平均每年增加0.8次。手术总平均次数(包括所有3种手术亚型)平均每年增加4.8例。结论:自2014年以来，研究员进行的MIGS手术数量不断增加，而每年进行的小梁切除术和水分流手术的总数保持不变，导致每年每位研究员进行的手术总数净增加。这表明MIGS的增加与青光眼患者小梁切除术或水分流术的大幅下降无关。财务披露:专有或商业披露可在本文末尾的脚注和披露中找到。

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引用次数: 0

Risk Calculation in the Medication Arm of the Ocular Hypertension Treatment Study 高眼压治疗研究用药组的风险计算。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2023-11-01 DOI: 10.1016/j.ogla.2023.06.005

Ari Leshno MD , Carlos Gustavo De Moraes MD, PhD , George A. Cioffi MD , Michael Kass MD , Mae Gordon PhD , Jeffrey M. Liebmann MD

Purpose

Risk assessment is integral to the management of individuals with ocular hypertension (OHTN). This study aims to determine the predictive accuracy of the Ocular Hypertension Treatment Study 5-year risk calculator (OHTS calculator) among treated patients with OHTN by applying it to patients randomized to the Ocular Hypertension Treatment Study (OHTS) medication arm.

Design

Post hoc secondary analysis of a randomized clinical trial.

Subjects

Individuals participating in the OHTS who were randomized to the medication arm. Only participants with complete baseline data in both eyes were included (n = 726).

Methods

The hazard ratios (HRs) of the medication group in OHTS were compared to the HR used for the OHTS calculator using the z-test statistic to establish the OHTS calculator's generalizability to the OHTS medication arm. The performance of the OHTS calculator among the OHTS medication group was evaluated twice, using both untreated baseline intraocular pressure (IOP) and average treated IOP during the first 24 months for the IOP variable.

Main Outcome Measures

The performance was determined based on the model’s accuracy in estimating the risk of reaching an OHTS primary open-angle glaucoma (POAG) end point using calibration chi-square and discriminating between participants who did or did not develop POAG.

Results

The HRs for the OHTS medication arm were not significantly different from those used in the OHTS calculator for untreated OHTN derived from observation arm data (P > 0.1). Based on the calibration chi-square test for the medication group, the OHTS calculator prediction model had good predictive accuracy when using the mean treated IOP and poorer predictive accuracy with the untreated baseline IOP (chi-square 10 and 29, respectively). The model had good discrimination with treated IOP (c-statistic = 0.77), comparable to what has been reported for the OHTS calculator in the OHTS observation group.

Conclusions

The OHTS calculator can be applied to treated patients with OHTN, and repeat risk calculation after initiating IOP reduction may provide useful information that can aid in disease management.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的:风险评估是管理高眼压患者(OHTN)不可或缺的一部分。本研究旨在通过将高眼压治疗研究5年风险计算器(OHTS计算器)应用于随机分配到高眼压治疗研究(OHTS)用药组的患者，确定高眼压治疗患者的预测准确性。设计:随机临床试验的事后二次分析。受试者:参加OHTS的个体被随机分配到药物组。仅纳入双眼基线数据完整的参与者(n = 726)。方法:将OHTS用药组的风险比(HR)与OHTS计算器使用的HR进行z检验统计量的比较，以建立OHTS计算器在OHTS用药组的通用性。使用未经治疗的基线眼压(IOP)和前24个月平均治疗的IOP作为IOP变量，对OHTS治疗组中OHTS计算器的性能进行了两次评估。主要结局指标:评估结果是基于模型在评估达到OHTS原发性开角型青光眼(POAG)终点的风险时的准确性，使用校准卡方并区分发生或未发生POAG的参与者。结果:OHTS用药组的hr与OHTS计算器中使用的观察组未治疗OHTN的hr无显著差异(P > 0.1)。基于给药组的校准卡方检验，OHTS计算器预测模型在使用平均治疗IOP时具有良好的预测准确性，而在使用未治疗的基线IOP时具有较差的预测准确性(卡方分别为10和29)。该模型对治疗后的IOP有很好的判别性(c-statistic = 0.77)，与OHTS观察组中OHTS计算器的报道相当。结论:OHTS计算器可用于治疗后的OHTN患者，并且在开始IOP降低后重复风险计算可能提供有用的信息，有助于疾病管理。财务披露:专有或商业披露可在本文末尾的脚注和披露中找到。

{"title":"Risk Calculation in the Medication Arm of the Ocular Hypertension Treatment Study","authors":"Ari Leshno MD , Carlos Gustavo De Moraes MD, PhD , George A. Cioffi MD , Michael Kass MD , Mae Gordon PhD , Jeffrey M. Liebmann MD","doi":"10.1016/j.ogla.2023.06.005","DOIUrl":"10.1016/j.ogla.2023.06.005","url":null,"abstract":"<div><h3>Purpose</h3><p>Risk assessment is integral to the management of individuals with ocular hypertension<span> (OHTN). This study aims to determine the predictive accuracy of the Ocular Hypertension Treatment Study 5-year risk calculator (OHTS calculator) among treated patients with OHTN by applying it to patients randomized to the Ocular Hypertension Treatment Study (OHTS) medication arm.</span></p></div><div><h3>Design</h3><p>Post hoc secondary analysis of a randomized clinical trial.</p></div><div><h3>Subjects</h3><p>Individuals participating in the OHTS who were randomized to the medication arm. Only participants with complete baseline data in both eyes were included (n = 726).</p></div><div><h3>Methods</h3><p>The hazard ratios (HRs) of the medication group in OHTS were compared to the HR used for the OHTS calculator using the z-test statistic to establish the OHTS calculator's generalizability to the OHTS medication arm. The performance of the OHTS calculator among the OHTS medication group was evaluated twice, using both untreated baseline intraocular pressure (IOP) and average treated IOP during the first 24 months for the IOP variable.</p></div><div><h3>Main Outcome Measures</h3><p>The performance was determined based on the model’s accuracy in estimating the risk of reaching an OHTS primary open-angle glaucoma (POAG) end point using calibration chi-square and discriminating between participants who did or did not develop POAG.</p></div><div><h3>Results</h3><p>The HRs for the OHTS medication arm were not significantly different from those used in the OHTS calculator for untreated OHTN derived from observation arm data (<em>P</em> > 0.1). Based on the calibration chi-square test for the medication group, the OHTS calculator prediction model had good predictive accuracy when using the mean treated IOP and poorer predictive accuracy with the untreated baseline IOP (chi-square 10 and 29, respectively). The model had good discrimination with treated IOP (c-statistic = 0.77), comparable to what has been reported for the OHTS calculator in the OHTS observation group.</p></div><div><h3>Conclusions</h3><p>The OHTS calculator can be applied to treated patients with OHTN, and repeat risk calculation after initiating IOP reduction may provide useful information that can aid in disease management.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"6 6","pages":"Pages 592-598"},"PeriodicalIF":2.9,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9855163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Single Administration of Bimatoprost Implant 单次施用比马前列素植入物:对24小时眼压和1年预后的影响。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2023-11-01 DOI: 10.1016/j.ogla.2023.06.007

Robert N. Weinreb MD , William C. Christie MD , Felipe A. Medeiros MD, PhD , E. Randy Craven MD , Kimmie Kim PhD , Ashley Nguyen PharmD , Marina Bejanian PhD , David L. Wirta MD

Purpose

To evaluate the effects of a single bimatoprost implant administration on 24-hour intraocular pressure (IOP) lowering at 8 weeks, and 1-year IOP-lowering efficacy and safety outcomes.

Design

Multicenter, open-label, 12-month, phase 3b study (NCT04285580).

Participants

Adults with open-angle glaucoma or ocular hypertension.

Methods

Participants (n = 31) received 10-μg bimatoprost implant in the study eye on day 1; IOP (sitting and/or supine) was measured with pneumatonometry every 2 hours throughout a 24-hour period at baseline and week 8. IOP was measured by Goldmann applanation tonometry (GAT) at hour 0 (8 am ± 1 hour) at baseline, weeks 8 and 16, and months 6, 9, and 12.

Main Outcome Measures

The primary endpoint was the week-8 hour-matched change from baseline in habitual position IOP over 24 hours assessed with pneumatonometry. Hour 0 IOP change from baseline measured with GAT in study eyes that received no additional (rescue) IOP-lowering treatment, treatment-emergent adverse events (TEAEs), and central corneal endothelial cell density (CECD) were evaluated through 12 months.

Results

The mean (standard deviation [SD]) baseline IOP at hour 0 was 24.2 (2.70) mmHg and 25.3 (7.15) mmHg by GAT and pneumatonometry, respectively. Pneumatonometer measurements of IOP taken over 24 hours at week 8 with the participant in habitual position (sitting from 8 am to 10 pm, supine from 12 am to 6 am) showed consistent IOP lowering through the day and night and reduced fluctuation in IOP. The range in IOP measurements over 24 hours was reduced from baseline by a mean (SD) of −1.6 (2.98) mmHg. All 31 bimatoprost implant–treated participants completed the 12-month study; 23 (74%) required no rescue IOP-lowering treatment. The mean (SD) IOP reduction from baseline at month 12 in nonrescued eyes was −4.3 (3.35) mmHg. The most common TEAE was conjunctival hyperemia (incidence 35.5%, 11/31). No implant-treated eye had a ≥ 15% loss in CECD from baseline.

Conclusions

A single intracameral administration of the bimatoprost implant lowered IOP in the habitual position consistently throughout the day and night at week 8. The majority of participants continued to have reduced IOP for 1 year without additional therapy. The 1-year safety profile was favorable.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的:评价单次给药比马前列素对8周24小时眼压(IOP)降低和1年眼压降低的疗效和安全性。设计:多中心，开放标签，12个月，3b期研究(NCT04285580)。受试者:成人开角型青光眼或高眼压患者。方法:参与者(n = 31)于第1天在研究眼内植入10 μg的比马前列素;IOP(坐位和/或仰卧位)在基线和第8周的24小时内每2小时用气压计测量一次。在基线0小时(上午8点±1小时)，第8周和第16周，第6、9和12个月，采用Goldmann眼压计(GAT)测量IOP。主要结局指标:主要终点是习惯体位IOP在24小时内与基线相匹配的周-8小时变化。在未接受额外(救助性)降低眼压治疗的研究眼睛中，GAT测量的0小时眼压与基线的变化，治疗出现的不良事件(teae)和中央角膜内皮细胞密度(ced)在12个月内进行评估。结果:GAT和气压计测量的0小时基线IOP平均值(标准差[SD])分别为24.2 (2.70)mmHg和25.3 (7.15)mmHg。在第8周，当参与者处于习惯体位(从早上8点到晚上10点坐着，从早上12点到早上6点仰卧)的24小时内，用气压计测量IOP，结果显示IOP在白天和晚上持续降低，IOP波动减少。24小时内IOP测量范围比基线平均(SD)减少-1.6 (2.98)mmHg。所有31名接受bimatoprost植入治疗的参与者完成了为期12个月的研究;23例(74%)不需要紧急降低眼压治疗。第12个月时，未抢救的眼睛的平均(SD) IOP较基线降低-4.3 (3.35)mmHg。最常见的TEAE是结膜充血(发生率35.5%，11/31)。没有植入物治疗的眼睛ced较基线下降≥15%。结论:在第8周，单次腹腔内施用比马前列素植入物可持续降低习惯体位的IOP。大多数参与者在没有额外治疗的情况下，IOP持续降低了1年。1年的安全性是有利的。财务披露:专有或商业披露可在本文末尾的脚注和披露中找到。

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引用次数: 0

Intermediate Outcomes of the Novel 63-μm Gelatin Microstent versus the Conventional 45-μm Gelatin Microstent 新型63-μm明胶微支架与传统45-μm明胶微支架的中期结果比较。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2023-11-01 DOI: 10.1016/j.ogla.2023.05.001

Isra M. Hussein MD, MSc , Ticiana De Francesco MD , Iqbal Ike K. Ahmed MD, FRCSC

<div><h3>Purpose</h3><p><span>To determine intermediate intraocular pressure (IOP)-lowering and adverse event profile of the 63-μm gelatin microstent (Xen63) with </span>mitomycin C (MMC) compared with the 45-μm gelatin microstent (Xen45) with MMC.</p></div><div><h3>Design</h3><p>Single center, consecutive, retrospective cohort study.</p></div><div><h3>Participants</h3><p>Eighty-four glaucomatous eyes (42 63-μm gelatin microstent and 42 45-μm gelatin microstent) with or without previous subconjunctival glaucoma surgery.</p></div><div><h3>Methods</h3><p>Consecutive eyes that underwent 63-μm gelatin microstent implantation with MMC from February 2020 to June 2021 were compared with eyes that underwent 45-μm gelatin microstent implantation with MMC. Standalone and combined cases with phacoemulsification were included.</p></div><div><h3>Main Outcome Measures</h3><p>Primary outcome was the hazard ratio of failure of 45-μm gelatin microstent vs. 63-μm gelatin microstent eyes at 12 months, with failure defined as 2 consecutive IOPs, (1) >17 mmHg, (2) <6 mmHg with 2 lines of vision loss<span>, or (3) <20% reduction from baseline IOP, without (complete) or with (qualified) glaucoma medications<span>. Secondary outcomes included IOP thresholds of 14 mmHg and 21 mmHg, postoperative IOP, medications, adverse events, interventions, and reoperations.</span></span></p></div><div><h3>Results</h3><p>The complete success rate was higher in the 63-μm gelatin microstent group (59.5% vs. 28.6%, <em>P</em> = 0.009) at the primary IOP threshold of 6 to 17 mmHg but did not differ significantly for qualified success (66.7% vs. 45.2%, <em>P</em> = 0.08). The crude hazard ratio of failure of 45-μm gelatin microstent relative to 63-μm gelatin microstent was 2.28 (95% confidence interval [CI], 1.21–4.32), and the adjusted hazard ratio was 7.90 (95% CI, 2.12–29.43). 63-μm gelatin microstent eyes had significantly lower mean IOP (12.7 ± 4.8 vs. 15.5 ± 5.1 mmHg, <em>P</em> = 0.001) and fewer medication classes (0.6 ± 1.1 vs. 1.7 ± 1.6 medications, <em>P</em> = 0.0005), with the degree of reduction in IOP and medication count being significantly greater in 63-μm gelatin microstent eyes. There were 28 and 21 distinct interventions in 63-μm gelatin microstent and 45-μm gelatin microstent eyes respectively, with 11.9% of eyes undergoing needling in each group. There were 34 and 19 distinct adverse events, in 63-μm gelatin microstent and 45-μm gelatin microstent eyes, respectively, most of which were early and transient. Nine Xen63 eyes (21.4%) and 6 45-μm gelatin microstent eyes (14.3%) underwent reoperation.</p></div><div><h3>Conclusions</h3><p>63-μm gelatin microstent resulted in higher surgical success rates and fewer medications compared with 45-μm gelatin microstent. This was tempered by more postoperative interventions and adverse events, although most were transient.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found i

目的:比较含有丝裂霉素C (MMC)的63-μm明胶微支架(Xen63)与含有MMC的45-μm明胶微支架(Xen45)的中间眼内压(IOP)降低和不良事件情况。设计:单中心、连续、回顾性队列研究。参与者:84只青光眼(42只63 μm明胶微支架和42只45 μm明胶微支架)，既往有或未做过结膜下青光眼手术。方法:将2020年2月至2021年6月连续行63 μm明胶MMC微支架植入术的眼与45 μm明胶MMC微支架植入术的眼进行比较。包括单独和联合超声乳化术的病例。主要结局指标:主要结局是45 μm明胶微支架组与63 μm明胶微支架组在12个月时眼睛失败的风险比，失败定义为连续2次IOP， (1) >17 mmHg，(2)结果:63 μm明胶微支架组在初始IOP阈值6 - 17 mmHg时完全成功率更高(59.5% vs 28.6%， P = 0.009)，但在合格成功方面无显著差异(66.7% vs 45.2%， P = 0.08)。45 μm明胶微支架相对于63 μm明胶微支架失效的粗风险比为2.28(95%可信区间[CI]， 1.21-4.32)，校正风险比为7.90 (95% CI, 2.12-29.43)。63 μm明胶微支架眼的平均IOP较低(12.7±4.8 vs 15.5±5.1 mmHg, P = 0.001)，药物种类较少(0.6±1.1 vs 1.7±1.6,P = 0.0005)，且63 μm明胶微支架眼的IOP降低程度和药物计数明显大于63 μm明胶微支架眼。63 μm明胶微支架眼和45 μm明胶微支架眼分别有28和21种不同的干预措施，每组有11.9%的眼进行针刺。63 μm明胶微支架组和45 μm明胶微支架组分别有34例和19例明显不良事件，大多数为早期和短暂性不良事件。9只Xen63眼(21.4%)和6只45 μm明胶微支架眼(14.3%)再次手术。结论:与45 μm明胶微支架相比，63 μm明胶微支架具有更高的手术成功率和更少的药物。术后更多的干预和不良事件缓和了这一点，尽管大多数是短暂的。财务披露:专有或商业披露可在本文末尾的脚注和披露中找到。

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引用次数: 3

Improved Prediction of Perimetric Loss in Glaucomatous Eyes Using Latent Class Mixed Modeling 使用潜在类别混合模型改进青光眼周视缺损的预测。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2023-11-01 DOI: 10.1016/j.ogla.2023.05.003

Swarup S. Swaminathan MD , Alessandro A. Jammal MD, PhD , J. Sunil Rao PhD , Felipe A. Medeiros MD, PhD

Purpose

To evaluate whether the identification of distinct classes within a population of glaucoma patients improves estimates of future perimetric loss.

Design

Longitudinal cohort study.

Participants

A total of 6558 eyes of 3981 subjects from the Duke Ophthalmic Registry with ≥ 5 reliable standard automated perimetry (SAP) tests and ≥ 2 years of follow-up.

Methods

Standard automated perimetry mean deviation (MD) values were extracted with associated timepoints. Latent class mixed models (LCMMs) were used to identify distinct subgroups (classes) of eyes according to rates of perimetric change over time. Rates for individual eyes were then estimated by considering both individual eye data and the most probable class membership for that eye. Data were split into training (80%) and test sets (20%), and test set mean squared prediction errors (MSPEs) were estimated using LCMM and ordinary least squares (OLS) regression.

Main Outcome Measures

Rates of change in SAP MD in each class and MSPE.

Results

The dataset contained 52 900 SAP tests with an average of 8.1 ± 3.7 tests per eye. The best-fitting LCMM contained 5 classes with rates of −0.06, −0.21, −0.87, −2.15, and +1.28dB/year (80.0%, 10.2%, 7.5%, 1.3%, and 1.0% of the population, respectively) labeled as slow, moderate, fast, catastrophic progressors, and “improvers” respectively. Fast and catastrophic progressors were older (64.1 ± 13.7 and 63.5 ± 16.9 vs. 57.8 ± 15.8, P < 0.001) and had generally mild-moderate disease at baseline (65.7% and 71% vs. 52%, P < 0.001) than slow progressors. The MSPE was significantly lower for LCMM compared to OLS, regardless of the number of tests used to obtain the rate of change (5.1 ± 0.6 vs. 60.2 ± 37.9, 4.9 ± 0.5 vs. 13.4 ± 3.2, 5.6 ± 0.8 vs. 8.1 ± 1.1, 3.4 ± 0.3 vs. 5.5 ± 1.1 when predicting the fourth, fifth, sixth, and seventh visual fields (VFs) respectively; P < 0.001 for all comparisons). MSPE of fast and catastrophic progressors was significantly lower with LCMM versus OLS (17.7 ± 6.9 vs. 48.1 ± 19.7, 27.1 ± 8.4 vs. 81.3 ± 27.1, 49.0 ± 14.7 vs. 183.9 ± 55.2, 46.6 ± 16.0 vs. 232.4 ± 78.0 when predicting the fourth, fifth, sixth, and seventh VFs respectively; P < 0.001 for all comparisons).

Conclusions

Latent class mixed model successfully identified distinct classes of progressors within a large glaucoma population that seemed to reflect subgroups observed in clinical practice. Latent class mixed models were superior to OLS regression in predicting future VF observations.

Financial Disclosure(s)

Proprietary or commercial disclosuremay be found after the references.

目的:评价在青光眼患者群体中区分不同类别是否能改善对未来视界损失的估计。设计:纵向队列研究。参与者:来自杜克眼科注册中心的3981名受试者，6558只眼睛，进行≥5次可靠的标准自动视野测量(SAP)测试，随访≥2年。方法:提取标准的自动视距平均偏差(MD)值及相关时间点。使用潜在类别混合模型(LCMMs)根据随时间的周长变化率来识别不同的眼睛亚组(类别)。然后通过考虑单个眼睛的数据和该眼睛最可能的类别成员来估计单个眼睛的比率。将数据分为训练集(80%)和测试集(20%)，并使用LCMM和普通最小二乘(OLS)回归估计测试集均方预测误差(mspe)。主要结果测量:每个班级和MSPE中SAP MD的变化率。结果:该数据集包含52 900次SAP测试，平均每只眼睛8.1±3.7次测试。最佳拟合LCMM包含5个类别，分别为-0.06，-0.21，-0.87，-2.15和+1.28dB/年(分别占人口的80.0%，10.2%，7.5%，1.3%和1.0%)，分别标记为缓慢，中等，快速，灾难性进展和“改善”。快速和灾难性进展者比缓慢进展者年龄更大(64.1±13.7和63.5±16.9对57.8±15.8,P < 0.001)，基线时一般为轻中度疾病(65.7%和71%对52%，P < 0.001)。在预测第4、第5、第6和第7视野(VFs)时，LCMM的MSPE与OLS相比显著降低，与获得变化率的试验次数无关(分别为5.1±0.6 vs. 60.2±37.9,4.9±0.5 vs. 13.4±3.2,5.6±0.8 vs. 8.1±1.1,3.4±0.3 vs. 5.5±1.1);所有比较P < 0.001)。在预测第4、5、6、7次VFs时，LCMM对快速进展者和灾难性进展者的MSPE显著低于OLS(17.7±6.9 vs 48.1±19.7,27.1±8.4 vs 81.3±27.1,49.0±14.7 vs 183.9±55.2,46.6±16.0 vs 232.4±78.0);所有比较P < 0.001)。结论:潜在类别混合模型成功地识别了大量青光眼人群中不同类别的进展者，这些进展者似乎反映了临床实践中观察到的亚组。潜在类别混合模型在预测未来VF观测值方面优于OLS回归。财务披露:可在参考文献后找到专有或商业披露。

{"title":"Improved Prediction of Perimetric Loss in Glaucomatous Eyes Using Latent Class Mixed Modeling","authors":"Swarup S. Swaminathan MD , Alessandro A. Jammal MD, PhD , J. Sunil Rao PhD , Felipe A. Medeiros MD, PhD","doi":"10.1016/j.ogla.2023.05.003","DOIUrl":"10.1016/j.ogla.2023.05.003","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate whether the identification of distinct classes within a population of glaucoma patients improves estimates of future perimetric loss.</p></div><div><h3>Design</h3><p>Longitudinal cohort study.</p></div><div><h3>Participants</h3><p>A total of 6558 eyes of 3981 subjects from the Duke Ophthalmic<span> Registry with ≥ 5 reliable standard automated perimetry (SAP) tests and ≥ 2 years of follow-up.</span></p></div><div><h3>Methods</h3><p>Standard automated perimetry mean deviation (MD) values were extracted with associated timepoints. Latent class mixed models (LCMMs) were used to identify distinct subgroups (classes) of eyes according to rates of perimetric change over time. Rates for individual eyes were then estimated by considering both individual eye data and the most probable class membership for that eye. Data were split into training (80%) and test sets (20%), and test set mean squared prediction errors (MSPEs) were estimated using LCMM and ordinary least squares (OLS) regression.</p></div><div><h3>Main Outcome Measures</h3><p>Rates of change in SAP MD in each class and MSPE.</p></div><div><h3>Results</h3><p>The dataset contained 52 900 SAP tests with an average of 8.1 ± 3.7 tests per eye. The best-fitting LCMM contained 5 classes with rates of −0.06, −0.21, −0.87, −2.15, and +1.28dB/year (80.0%, 10.2%, 7.5%, 1.3%, and 1.0% of the population, respectively) labeled as slow, moderate, fast, catastrophic progressors, and “improvers” respectively. Fast and catastrophic progressors were older (64.1 ± 13.7 and 63.5 ± 16.9 vs. 57.8 ± 15.8, <em>P</em> < 0.001) and had generally mild-moderate disease at baseline (65.7% and 71% vs. 52%, <em>P</em> < 0.001) than slow progressors. The MSPE was significantly lower for LCMM compared to OLS, regardless of the number of tests used to obtain the rate of change (5.1 ± 0.6 vs. 60.2 ± 37.9, 4.9 ± 0.5 vs. 13.4 ± 3.2, 5.6 ± 0.8 vs. 8.1 ± 1.1, 3.4 ± 0.3 vs. 5.5 ± 1.1 when predicting the fourth, fifth, sixth, and seventh visual fields (VFs) respectively; <em>P</em> < 0.001 for all comparisons). MSPE of fast and catastrophic progressors was significantly lower with LCMM versus OLS (17.7 ± 6.9 vs. 48.1 ± 19.7, 27.1 ± 8.4 vs. 81.3 ± 27.1, 49.0 ± 14.7 vs. 183.9 ± 55.2, 46.6 ± 16.0 vs. 232.4 ± 78.0 when predicting the fourth, fifth, sixth, and seventh VFs respectively; <em>P</em> < 0.001 for all comparisons).</p></div><div><h3>Conclusions</h3><p>Latent class mixed model successfully identified distinct classes of progressors within a large glaucoma population that seemed to reflect subgroups observed in clinical practice. Latent class mixed models were superior to OLS regression in predicting future VF observations.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosuremay be found after the references.</p></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"6 6","pages":"Pages 642-650"},"PeriodicalIF":2.9,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9635527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Association of Neighborhood Environment with the Outcomes of Childhood Glaucoma 邻里环境与儿童青光眼预后的关系。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2023-11-01 DOI: 10.1016/j.ogla.2023.06.001

Abdelrahman M. Elhusseiny MD, MSc , Isdin Oke MD , Jean Adomfeh MD , Muhammad Z. Chauhan MA, MS , Deborah K. VanderVeen MD

Purpose

To determine the association between different neighborhood environment factors and the outcomes of childhood glaucoma.

Design

A retrospective cohort.

Participants

Childhood glaucoma patients ≤ 18 years of age at the time of diagnosis.

Methods

A retrospective chart review of childhood glaucoma patients who presented to Boston Children’s Hospital between 2014 and 2019. Data collected included etiology, intraocular pressure (IOP), management, and visual outcomes. Child Opportunity Index (COI) was used as a metric of neighborhood quality.

Main Outcomes Measures

The association of visual acuity (VA) and IOP with COI scores using linear mixed-effect models, adjusting for individual demographics.

Results

A total of 221 eyes (149 patients) were included. Of these, 54.36% were male and 56.4% were non-Hispanic Whites. The median age at the time of presentation was 5 months for primary glaucoma and 5 years for secondary glaucoma. The median age at the last follow-up was 6 and 13 years for primary and secondary glaucoma, respectively. A chi-square test revealed that the COI, health and environment, social and economic, and education indexes between primary and secondary glaucoma patients were comparable. For primary glaucoma, the overall COI and a higher education index were associated with a lower final IOP (P < 0.05), and higher education index was associated with a lower number of glaucoma medications at the last follow-up (P < 0.05). For secondary glaucoma, higher overall COI, health and environment, social and economic, and education indices were associated with better final VA (lower logarithms of the minimum angle of resolution VA) (P < 0.001).

Conclusions

Neighborhood environment quality is a potentially important variable for predicting outcomes in childhood glaucoma. Lower COI scores were associated with worse outcomes.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

目的:探讨不同社区环境因素与儿童青光眼预后的关系。设计:回顾性队列研究。研究对象:诊断时年龄≤18岁的儿童青光眼患者。方法:回顾性分析2014年至2019年在波士顿儿童医院就诊的儿童青光眼患者。收集的数据包括病因、眼压(IOP)、管理和视力结果。儿童机会指数(COI)被用作社区质量的度量。主要结果测量:使用线性混合效应模型，根据个体人口统计学调整视力(VA)和IOP与COI评分的关系。结果:共纳入221只眼(149例)。其中54.36%为男性，56.4%为非西班牙裔白人。原发性青光眼的中位年龄为5个月，继发性青光眼的中位年龄为5岁。原发性青光眼和继发性青光眼最后一次随访时的中位年龄分别为6岁和13岁。卡方检验显示，原发性与继发性青光眼患者的COI、健康与环境、社会经济、教育等指标具有可比性。对于原发性青光眼，总体COI和高等教育指数与较低的最终IOP (P)相关。结论:社区环境质量是预测儿童青光眼预后的潜在重要变量。较低的COI分数与较差的结果相关。财务披露:专有或商业披露可在本文末尾的脚注和披露中找到。

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引用次数: 2

Spontaneous Filtering Blebs in a Young Woman 一个年轻女人的自发滤泡。

IF 2.9 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma

Pub Date : 2023-11-01 DOI: 10.1016/j.ogla.2023.08.008

Sonam Yangzes MS, Faisal Thattaruthody MS, Surinder Singh Pandav MS

引用次数: 0