Primary congenital glaucoma (PCG) is a potentially blinding disease, and the search for the best surgical option always remains. This study investigated the efficacy of Bent Ab-Interno Needle Goniectomy (BANG) compared to the established standard of traditional goniotomy.
Design
Parallel-group randomized controlled trial.
Participants
Infants with PCG aged 1 month to 1 year with similar clinical features in both eyes.
Intervention
The 2 eyes of eligible patients were randomized to either goniotomy or BANG using a 25-gauge needle bent as a reverse cystitome, and the surgeries were done on the same day in both eyes. Postoperatively each infant was followed up for a minimum period of 1 year.
Main Outcome Measures
The primary outcomes measured were intraocular pressure (IOP) control and the requirement for antiglaucoma medications (AGMs). The secondary outcome measures included corneal clarity enhancement, axial length stability, incidence of surgical complications, or the need for repeat surgery.
Results
Eight infants with both eyes eligible, were included. In each infant, 1 eye was randomized to BANG and the other to conventional goniotomy. The mean age was 7.6 ± 3.6 months. There was no significant difference in the mean preoperative IOP (16.8 ± 8.87 mm Hg vs. 17 ± 6.0 mm Hg; P = 0.48) in eyes randomized to goniotomy or BANG. The mean number of AGMs (1.7 ± 1.11 vs. 2 ± 0.81 respectively; P = 0.26) were similar in both groups. Postoperatively, the IOP at 6 months (14.05 ± 4.1 vs. 16.2 ± 4.07; P = 0.22) and 1 year (15.3 ± 3.4 vs. 17.1 ± 3.0; P = 0.15) were similar in eyes that underwent goniotomy or BANG respectively. Both procedures demonstrated significant improvements in corneal clarity and maintained normal axial length growth. However, the BANG group required slightly more AGMs than the goniotomy group. There were no serious complications in either group. Both eyes of 1 patient required repeat surgery for IOP control and underwent a combined trabeculotomy with trabeculectomy at 9 months and 1 year postoperatively, respectively.
Conclusions
This study indicates that goniotomy remains an effective surgical treatment for PCG. The absence of discernible superiority in IOP control or overall outcomes implies that the added complexity of excising the trabecular meshwork in BANG may not confer additional benefits over the established approach.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
目的：原发性先天性青光眼（PCG）是一种潜在的致盲性疾病，人们一直在寻找最佳的手术方案。本研究调查了弯曲腹腔内针眼球切开术（BANG）与传统眼球切开术的既定标准相比的疗效：设计：平行分组随机对照试验 参与者：患有 PCG 的一个月至一岁婴儿，双眼临床特征相似：符合条件的患者的双眼随机接受开孔术或 BANG 术，使用 25 号针头弯曲作为反向膀胱镜，双眼在同一天进行手术。术后对每个婴儿进行至少一年的随访：测量的主要结果是眼压（IOP）控制和抗青光眼药物（AGMs）需求。次要结果包括角膜透明度的提高、轴向长度的稳定性、手术并发症的发生率或是否需要再次手术：共纳入了 8 名双眼均符合条件的婴儿。每个婴儿的一只眼睛随机接受 BANG 手术，另一只眼睛接受传统的眼球切开术。婴儿的平均年龄为 7.6±3.6 个月。随机接受眼球切开术或 BANG 术的婴儿术前平均眼压无明显差异（16.8 +8.87 mm Hg 对 17+6.0 mm Hg；P=0.48）。两组的 AGM 平均数（分别为 1.7±1.11 对 2+0.81；P=0.26）相似。术后 6 个月（14.05+4.1 对 16.2+4.07；P=0.22）和 1 年（15.3 ± 3.4 对 17.1 + 3.0；P=0.15）的眼压分别与眼球切开术和 BANG 术相似。两种手术都明显改善了角膜透明度，并保持了正常的轴长增长。不过，BANG 组所需的 AGM 略多于眼球切开术组。两组患者均未出现严重并发症。一名患者的双眼需要再次手术以控制眼压，并分别在术后九个月和一年时接受了联合小梁切开术和小梁切除术：本研究表明，眼球切开术仍然是治疗 PCG 的有效手术方法。结论：本研究表明，开颅手术仍然是治疗 PCG 的有效手术方法，但在眼压控制或总体疗效方面并无明显优势，这意味着 BANG 术中切除小梁网所增加的复杂性可能不会带来比既有方法更多的益处。
{"title":"Comparison of Bent Ab-Interno Needle Goniectomy and Goniotomy in Primary Congenital Glaucoma","authors":"Sushmita Kaushik MS, FAICO, Kajree Gupta MS, Shrushti Hunashyal MBBS, Manik Sardana MS, Faisal Thattaruthody MS, Surinder Singh Pandav MS","doi":"10.1016/j.ogla.2024.08.003","DOIUrl":"10.1016/j.ogla.2024.08.003","url":null,"abstract":"<div><h3>Purpose</h3><div>Primary congenital glaucoma (PCG) is a potentially blinding disease, and the search for the best surgical option always remains. This study investigated the efficacy of Bent Ab-Interno Needle Goniectomy (BANG) compared to the established standard of traditional goniotomy.</div></div><div><h3>Design</h3><div>Parallel-group randomized controlled trial.</div></div><div><h3>Participants</h3><div>Infants with PCG aged 1 month to 1 year with similar clinical features in both eyes.</div></div><div><h3>Intervention</h3><div>The 2 eyes of eligible patients were randomized to either goniotomy or BANG using a 25-gauge needle bent as a reverse cystitome, and the surgeries were done on the same day in both eyes. Postoperatively each infant was followed up for a minimum period of 1 year.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcomes measured were intraocular pressure (IOP) control and the requirement for antiglaucoma medications (AGMs). The secondary outcome measures included corneal clarity enhancement, axial length stability, incidence of surgical complications, or the need for repeat surgery.</div></div><div><h3>Results</h3><div>Eight infants with both eyes eligible, were included. In each infant, 1 eye was randomized to BANG and the other to conventional goniotomy. The mean age was 7.6 ± 3.6 months. There was no significant difference in the mean preoperative IOP (16.8 ± 8.87 mm Hg vs. 17 ± 6.0 mm Hg; <em>P</em> = 0.48) in eyes randomized to goniotomy or BANG. The mean number of AGMs (1.7 ± 1.11 vs. 2 ± 0.81 respectively; <em>P</em> = 0.26) were similar in both groups. Postoperatively, the IOP at 6 months (14.05 ± 4.1 vs. 16.2 ± 4.07; <em>P</em> = 0.22) and 1 year (15.3 ± 3.4 vs. 17.1 ± 3.0; <em>P</em> = 0.15) were similar in eyes that underwent goniotomy or BANG respectively. Both procedures demonstrated significant improvements in corneal clarity and maintained normal axial length growth. However, the BANG group required slightly more AGMs than the goniotomy group. There were no serious complications in either group. Both eyes of 1 patient required repeat surgery for IOP control and underwent a combined trabeculotomy with trabeculectomy at 9 months and 1 year postoperatively, respectively.</div></div><div><h3>Conclusions</h3><div>This study indicates that goniotomy remains an effective surgical treatment for PCG. The absence of discernible superiority in IOP control or overall outcomes implies that the added complexity of excising the trabecular meshwork in BANG may not confer additional benefits over the established approach.</div></div><div><h3>Financial Disclosure(s)</h3><div>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 1","pages":"Pages 46-52"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057426","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}
Pub Date : 2025-01-01DOI: 10.1016/j.ogla.2024.07.009
Yan Shi MD, PhD , Junming Hu PhD , William Liu , Wei Qiao Qiu MD, PhD , Xinyue He MD, PhD , Miao Zhang MD , Yan Gao MD , Xiaoling Zhang MD, PhD , Zhigang Fan MD, PhD
Objective
To explore the impact of the apolipoprotein E (APOE) E4 allele in the gender-specific aging process in glaucoma by illustrating the interaction between risk factors, including the APOE E4 allele, gender, and intraocular pressure (IOP), for age at diagnosis (AAD) of glaucoma.
Design
A cross-sectional study included UK Biobank participants with complete data (2006–2010) for analysis. Data were analyzed in December 2023.
Participants
Two thousand two hundred thirty-six glaucoma patients and 103 232 controls.
Methods
We evaluated multivariable-adjusted associations of AAD of glaucoma, APOE E4 allele (0: absence; 1: presence), and IOP using linear mixed model (LMM) analyses across groups stratified by AAD of mean age of menopause (50 years) and gender.
Main Outcomes Measures
Age at diagnosis of glaucoma, APOE E4 allele, and IOP.
Results
Patients with glaucoma were older and had a higher percentage of males and a higher mean IOP compared to controls (all P < 0.001). Further stratifying the patients with glaucoma by AAD of 50 and gender, lower IOP (model 1 adjusted by age, βIOP = −0.096 ± 0.041, P = 0.019), and positive APOE E4 allele (model 2 adjusted by age and IOP, βe4 = 1.093 ± 0.488, P = 0.026) were associated with an older AAD in females with an AAD <50 years under univariate LMM. In multivariate LMM adjusted by age (model 3), the effect size of both factors increased in the multivariate model as the beta-value increased (βIOP = −0.111 ± 0.040, P = 0.007; βe4 = 1.235 ± 0.485, P = 0.012) (model 1 vs. model 3: P = 0.011). In females with an AAD ≥50 years, only positive APOE E4 allele (adjusted by age and IOP, βe4 = −1.121 ± 0.412, P = 0.007) was associated with a younger AAD. In males, only higher IOP was associated with an older AAD in those with an AAD ≥50 years (βIOP = 0.088 ± 0.032, P = 0.006).
Conclusions
Apolipoprotein E E4 allele may initially delay and later accelerate the development of glaucoma in females around the transition period of 50 years, which is the mean age of menopause, and importantly, this is independent of IOP. Understanding the specific transition states and modifiable factors within each age phase is crucial for developing interventions or strategies that promote healthy aging.
Financial Disclosures
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Female-Specific Association between the Apolipoprotein E E4 Allele and Age at Diagnosis of Glaucoma in UK Biobank","authors":"Yan Shi MD, PhD , Junming Hu PhD , William Liu , Wei Qiao Qiu MD, PhD , Xinyue He MD, PhD , Miao Zhang MD , Yan Gao MD , Xiaoling Zhang MD, PhD , Zhigang Fan MD, PhD","doi":"10.1016/j.ogla.2024.07.009","DOIUrl":"10.1016/j.ogla.2024.07.009","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the impact of the apolipoprotein E (<em>APOE</em>) E4 allele in the gender-specific aging process in glaucoma by illustrating the interaction between risk factors, including the <em>APOE</em> E4 allele, gender, and intraocular pressure (IOP), for age at diagnosis (AAD) of glaucoma.</div></div><div><h3>Design</h3><div>A cross-sectional study included UK Biobank participants with complete data (2006–2010) for analysis. Data were analyzed in December 2023.</div></div><div><h3>Participants</h3><div>Two thousand two hundred thirty-six glaucoma patients and 103 232 controls.</div></div><div><h3>Methods</h3><div>We evaluated multivariable-adjusted associations of AAD of glaucoma, <em>APOE</em> E4 allele (0: absence; 1: presence), and IOP using linear mixed model (LMM) analyses across groups stratified by AAD of mean age of menopause (50 years) and gender.</div></div><div><h3>Main Outcomes Measures</h3><div>Age at diagnosis of glaucoma, <em>APOE</em> E4 allele, and IOP.</div></div><div><h3>Results</h3><div>Patients with glaucoma were older and had a higher percentage of males and a higher mean IOP compared to controls (all <em>P</em> < 0.001). Further stratifying the patients with glaucoma by AAD of 50 and gender, lower IOP (model 1 adjusted by age, β<sub>IOP</sub> = −0.096 ± 0.041, <em>P</em> = 0.019), and positive <em>APOE</em> E4 allele (model 2 adjusted by age and IOP, β<sub>e4</sub> = 1.093 ± 0.488, <em>P</em> = 0.026) were associated with an older AAD in females with an AAD <50 years under univariate LMM. In multivariate LMM adjusted by age (model 3), the effect size of both factors increased in the multivariate model as the beta-value increased (β<sub>IOP</sub> = −0.111 ± 0.040, <em>P</em> = 0.007; β<sub>e4</sub> = 1.235 ± 0.485, <em>P</em> = 0.012) (model 1 vs. model 3: <em>P</em> = 0.011). In females with an AAD ≥50 years, only positive <em>APOE</em> E4 allele (adjusted by age and IOP, β<sub>e4</sub> = −1.121 ± 0.412, <em>P</em> = 0.007) was associated with a younger AAD. In males, only higher IOP was associated with an older AAD in those with an AAD ≥50 years (β<sub>IOP</sub> = 0.088 ± 0.032, <em>P</em> = 0.006).</div></div><div><h3>Conclusions</h3><div>Apolipoprotein E E4 allele may initially delay and later accelerate the development of glaucoma in females around the transition period of 50 years, which is the mean age of menopause, and importantly, this is independent of IOP. Understanding the specific transition states and modifiable factors within each age phase is crucial for developing interventions or strategies that promote healthy aging.</div></div><div><h3>Financial Disclosures</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"8 1","pages":"Pages 53-62"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891172","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}
Pub Date : 2024-11-01DOI: 10.1016/j.ogla.2024.06.004
Matthew N. Henderson MD , Hartej Singh BS , Lucy S. Guan MPH , Ang Li MD , Jonathan L. Prenner MD
Purpose
To provide relative citation ratio (RCR) benchmark data for the field of glaucoma.
Design
Cross-sectional bibliometric analysis.
Subjects
Fellowship-trained glaucoma faculty at Accreditation Council for Graduate Medical Education-accredited institutions.
Methods
Glaucoma faculty were individually indexed using the National Institutes of Health (NIH) iCite website. Publication count, mean RCR score, and weighted RCR score were collected for each author between May and August 2023 and included PubMed-listed articles from 1980 to 2023. Data were compared by sex, career duration, academic rank, and acquisition of a Doctor of Philosophy (PhD).
Main Outcome Measures
Total number of publications, mean RCR value, and weighted RCR value.
Results
Five hundred twenty-six academic glaucoma specialists from 113 institutions were indexed. These physicians produced highly impactful research with a median publication count of 13 (interquartile range [IQR] 4–38), median RCR of 1.41 (IQR 0.97–1.98), and median weighted RCR of 16.89 (4.80–63.39). Academic rank, career duration, and having a PhD were associated with increased publication count, mean RCR, and weighted RCR. Publication count and weighted RCR differed significantly by sex; however, no difference was observed with mean RCR.
Conclusions
Current academic glaucoma specialists have high mean RCR values relative to the NIH standard RCR value of 1. This benchmark data serve as a more accurate gauge of research impact within the glaucoma community and can be used to inform self, institutional, and departmental evaluations. Additionally, the mean RCR may provide an accurate metric for quantifying research productivity among historically underrepresented groups that are disadvantaged by time-dependent factors such as number of publications.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Evaluation of Research Productivity among Academic Glaucoma Specialists Using the Relative Citation Ratio","authors":"Matthew N. Henderson MD , Hartej Singh BS , Lucy S. Guan MPH , Ang Li MD , Jonathan L. Prenner MD","doi":"10.1016/j.ogla.2024.06.004","DOIUrl":"10.1016/j.ogla.2024.06.004","url":null,"abstract":"<div><h3>Purpose</h3><div>To provide relative citation ratio (RCR) benchmark data for the field of glaucoma.</div></div><div><h3>Design</h3><div>Cross-sectional bibliometric analysis.</div></div><div><h3>Subjects</h3><div>Fellowship-trained glaucoma faculty at Accreditation Council for Graduate Medical Education-accredited institutions.</div></div><div><h3>Methods</h3><div>Glaucoma faculty were individually indexed using the National Institutes of Health (NIH) iCite website. Publication count, mean RCR score, and weighted RCR score were collected for each author between May and August 2023 and included PubMed-listed articles from 1980 to 2023. Data were compared by sex, career duration, academic rank, and acquisition of a Doctor of Philosophy (PhD).</div></div><div><h3>Main Outcome Measures</h3><div>Total number of publications, mean RCR value, and weighted RCR value.</div></div><div><h3>Results</h3><div>Five hundred twenty-six academic glaucoma specialists from 113 institutions were indexed. These physicians produced highly impactful research with a median publication count of 13 (interquartile range [IQR] 4–38), median RCR of 1.41 (IQR 0.97–1.98), and median weighted RCR of 16.89 (4.80–63.39). Academic rank, career duration, and having a PhD were associated with increased publication count, mean RCR, and weighted RCR. Publication count and weighted RCR differed significantly by sex; however, no difference was observed with mean RCR.</div></div><div><h3>Conclusions</h3><div>Current academic glaucoma specialists have high mean RCR values relative to the NIH standard RCR value of 1. This benchmark data serve as a more accurate gauge of research impact within the glaucoma community and can be used to inform self, institutional, and departmental evaluations. Additionally, the mean RCR may provide an accurate metric for quantifying research productivity among historically underrepresented groups that are disadvantaged by time-dependent factors such as number of publications.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 6","pages":"Pages 531-538"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437862","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}
Pub Date : 2024-11-01DOI: 10.1016/j.ogla.2024.08.002
Kuldev Singh MD, MPH
{"title":"Reprint of: Transactional Care and the Looming Glaucoma Public Health Crisis","authors":"Kuldev Singh MD, MPH","doi":"10.1016/j.ogla.2024.08.002","DOIUrl":"10.1016/j.ogla.2024.08.002","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 6","pages":"Pages 515-517"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693924","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}
Pub Date : 2024-11-01DOI: 10.1016/j.ogla.2024.07.002
Jeremy C.K. Tan MD, FRANZCO , Yohei Hashimoto MD, PhD , Pierre Henry Gabrielle PhD , Catherine Creuzot Garcher MD, PhD , Andrew White PhD, FRANZCO , Hamish Dunn MBBS, FRANZCO , Mark Walland FRANZCO, FRACS , David Wechsler MBBS, FRANZCO , Louis Arnould MD, PhD , Mitchell Lawlor PhD, FRANZCO
<div><h3>Purpose</h3><div>To compare safety, effectiveness, and baseline predictors of failure in standalone primary Xen45 gel stent (Xen) versus trabeculectomy (Trab) in glaucoma.</div></div><div><h3>Design</h3><div>Retrospective study.</div></div><div><h3>Subjects</h3><div>Subjects that underwent primary Xen or Trab augmented by mitomycin-C with at least 12 months follow-up.</div></div><div><h3>Methods</h3><div>Multinational observational study of eyes in the Fight Glaucoma Blindness international registry</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was success at 12 months defined by intraocular pressure (IOP) reduction ≥ 20% from baseline and ≤ threshold IOPs of 15, 18, and 21 mmHg with (qualified) or without (complete) medications and without secondary glaucoma surgery. Multivariable mixed effects Cox regression models were used to identify risk factors for failure in each cohort.</div></div><div><h3>Results</h3><div>A total of 701 eyes (Xen, 308; Trab, 393) of 596 subjects were included with baseline IOP being significantly higher (22.4 vs. 19.9 mmHg, <em>P</em> < 0.001) and baseline medications significantly lower in the Xen versus the Trab group (2.9 vs. 3.4, <em>P</em> < 0.001). Baseline visual field mean deviation was less severe in the Xen group (–9.47 vs. –13.04 dB, <em>P</em> < 0.001). The proportion of complete surgical success was significantly lower in the Xen versus Trab group across the 3 upper IOP limits at 12 months; 32% versus 52% at 15 mmHg, 37% versus 54% at 18 mmHg, and 39% versus 55% at 21 mmHg (<em>P</em> < 0.001). The incidence of postoperative numerical and symptomatic hypotony was lower in the Xen versus Trab group. In the Xen cohort, a higher failure rate was associated with Asian ethnicity (hazard ratio [HR], 1.97; 95% confidence interval (CI), 1.03–3.79) and use of oral acetazolamide at baseline (HR, 1.74; 95% CI, 1.13–2.70), whereas a lower failure rate was associated with diagnosis of ocular hypertension/open-angle glaucoma suspect (HR, 0.40; 95% CI, 0.20–0.82) and secondary open-angle glaucoma (HR, 0.46; 95% CI, 0.26–0.82). Exposure to prostaglandin analog was associated with greater failure in the Trab group (HR, 2.66; 95% CI, 1.18–6.01).</div></div><div><h3>Conclusions</h3><div>There was significantly greater complete success at 12 months across all complete success definitions for Trab compared with Xen, whereas the rate of postoperative hypotony was significantly lower in the Xen group. Asian ethnicity and use of oral acetazolamide at baseline were associated with greater failure in Xen, whereas exposure to prostaglandin analog was associated with greater failure in Trab patients. Such baseline predictors of success and failure may help guide patient selection for subconjunctival minimally invasive glaucoma surgery in patients undergoing surgical intervention.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the F
目的：比较独立初级Xen45凝胶支架（Xen）与小梁切除术（Trab）治疗青光眼的安全性、有效性和失败的基线预测因素：设计：回顾性研究：随访至少12个月并接受Xen或Trab术后丝裂霉素-C辅助治疗的受试者：主要结果测量：主要结果是 12 个月时的成功率，定义为眼压较基线降低≥ 20%，且眼压≤ 15mmHg、18mmHg 和 21mmHg 临界值，有（合格）或无（完全）药物治疗，且未进行二次青光眼手术。多变量混合效应考克斯回归模型用于确定每个队列中失败的风险因素：596名受试者中有701只眼睛（Xen组，308只；Trab组，393只）入选，Xen组与Trab组相比，基线眼压明显更高（22.4 mmHg vs 19.9 mmHg，p < 0.001），基线用药明显更少（2.9 mmHg vs 3.4 mmHg，p 结论：Xen组与Trab组相比，基线用药明显更少（2.9 mmHg vs 3.4 mmHg，p < 0.001）：在所有完全成功定义中，Trab组在12个月时的完全成功率明显高于Xen组，而Xen组的术后低张力率明显低于Trab组。亚裔和基线使用口服乙酰唑胺与 Xen 的更大失败率相关，而前列腺素类似物与 Trab 患者的更大失败率相关。这些成功和失败的基线预测因素有助于指导接受手术干预的患者选择结膜下微创青光眼手术。
{"title":"Outcomes and Baseline Predictors of Failure in Primary Standalone Xen45 Gel Stent versus Trabeculectomy for Glaucoma","authors":"Jeremy C.K. Tan MD, FRANZCO , Yohei Hashimoto MD, PhD , Pierre Henry Gabrielle PhD , Catherine Creuzot Garcher MD, PhD , Andrew White PhD, FRANZCO , Hamish Dunn MBBS, FRANZCO , Mark Walland FRANZCO, FRACS , David Wechsler MBBS, FRANZCO , Louis Arnould MD, PhD , Mitchell Lawlor PhD, FRANZCO","doi":"10.1016/j.ogla.2024.07.002","DOIUrl":"10.1016/j.ogla.2024.07.002","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare safety, effectiveness, and baseline predictors of failure in standalone primary Xen45 gel stent (Xen) versus trabeculectomy (Trab) in glaucoma.</div></div><div><h3>Design</h3><div>Retrospective study.</div></div><div><h3>Subjects</h3><div>Subjects that underwent primary Xen or Trab augmented by mitomycin-C with at least 12 months follow-up.</div></div><div><h3>Methods</h3><div>Multinational observational study of eyes in the Fight Glaucoma Blindness international registry</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was success at 12 months defined by intraocular pressure (IOP) reduction ≥ 20% from baseline and ≤ threshold IOPs of 15, 18, and 21 mmHg with (qualified) or without (complete) medications and without secondary glaucoma surgery. Multivariable mixed effects Cox regression models were used to identify risk factors for failure in each cohort.</div></div><div><h3>Results</h3><div>A total of 701 eyes (Xen, 308; Trab, 393) of 596 subjects were included with baseline IOP being significantly higher (22.4 vs. 19.9 mmHg, <em>P</em> < 0.001) and baseline medications significantly lower in the Xen versus the Trab group (2.9 vs. 3.4, <em>P</em> < 0.001). Baseline visual field mean deviation was less severe in the Xen group (–9.47 vs. –13.04 dB, <em>P</em> < 0.001). The proportion of complete surgical success was significantly lower in the Xen versus Trab group across the 3 upper IOP limits at 12 months; 32% versus 52% at 15 mmHg, 37% versus 54% at 18 mmHg, and 39% versus 55% at 21 mmHg (<em>P</em> < 0.001). The incidence of postoperative numerical and symptomatic hypotony was lower in the Xen versus Trab group. In the Xen cohort, a higher failure rate was associated with Asian ethnicity (hazard ratio [HR], 1.97; 95% confidence interval (CI), 1.03–3.79) and use of oral acetazolamide at baseline (HR, 1.74; 95% CI, 1.13–2.70), whereas a lower failure rate was associated with diagnosis of ocular hypertension/open-angle glaucoma suspect (HR, 0.40; 95% CI, 0.20–0.82) and secondary open-angle glaucoma (HR, 0.46; 95% CI, 0.26–0.82). Exposure to prostaglandin analog was associated with greater failure in the Trab group (HR, 2.66; 95% CI, 1.18–6.01).</div></div><div><h3>Conclusions</h3><div>There was significantly greater complete success at 12 months across all complete success definitions for Trab compared with Xen, whereas the rate of postoperative hypotony was significantly lower in the Xen group. Asian ethnicity and use of oral acetazolamide at baseline were associated with greater failure in Xen, whereas exposure to prostaglandin analog was associated with greater failure in Trab patients. Such baseline predictors of success and failure may help guide patient selection for subconjunctival minimally invasive glaucoma surgery in patients undergoing surgical intervention.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the F","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 6","pages":"Pages 539-550"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617695","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}
Pub Date : 2024-11-01DOI: 10.1016/j.ogla.2024.06.006
Irene Koc BS , Demetrios G. Vavvas MD, PhD , Teresa C. Chen MD
{"title":"Insight on the Optic Nerve and Ahmed Valve Tube through a Type II Keratoprosthesis","authors":"Irene Koc BS , Demetrios G. Vavvas MD, PhD , Teresa C. Chen MD","doi":"10.1016/j.ogla.2024.06.006","DOIUrl":"10.1016/j.ogla.2024.06.006","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 6","pages":"Page e13"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635974","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}
Pub Date : 2024-11-01DOI: 10.1016/j.ogla.2024.08.006
Vitor Porto de Souza MD , Fábio Nishimura Kanadani MD, PhD , Augusto Paranhos Jr. MD, PhD , Tiago Santos Prata MD, PhD
{"title":"Re: Chan et al.: Effect of preoperative trabecular meshwork pigmentation and other eye characteristics on outcomes of combined phacoemulsification/minimally invasive glaucoma surgery (Ophthalmol Glaucoma. 2024; 7:271-281)","authors":"Vitor Porto de Souza MD , Fábio Nishimura Kanadani MD, PhD , Augusto Paranhos Jr. MD, PhD , Tiago Santos Prata MD, PhD","doi":"10.1016/j.ogla.2024.08.006","DOIUrl":"10.1016/j.ogla.2024.08.006","url":null,"abstract":"","PeriodicalId":19519,"journal":{"name":"Ophthalmology. Glaucoma","volume":"7 6","pages":"Page e7"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382581","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}
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