Risk Factors for Failure in Glaucoma Patients Undergoing Microshunt Implantation.

Autor: Rabiolo A; From the Department of Ophthalmology (A.R., P.D., A.C., S.D.C.), University Hospital Maggiore della Carità, Novara, Italy; Department of Health Sciences (A.R., S.D.C.), Università del Piemonte Orientale 'Amedeo Avogadro', Novara, Italy. Electronic address: rabiolo.alessandro@gmail.com., Toscani R; Department of Ophthalmology (R.T., P.B., C.C., F.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy., Sacchi M; Department of Ophthalmology (M.S., G.L.C., P.N.), San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy., Destefanis P; From the Department of Ophthalmology (A.R., P.D., A.C., S.D.C.), University Hospital Maggiore della Carità, Novara, Italy., Bettin P; Department of Ophthalmology (R.T., P.B., C.C., F.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy., Ciampi C; Department of Ophthalmology (R.T., P.B., C.C., F.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy., Clemente A; From the Department of Ophthalmology (A.R., P.D., A.C., S.D.C.), University Hospital Maggiore della Carità, Novara, Italy., Cutolo CA; DiNOGMI (C.A.C., M.I., C.E.T.), Università di Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino (C.A.C., M.I., C.E.T.), Genova, Italy., Mercieca K; Department of Ophthalmology (K.M.), University Hospital Bonn, Bonn, Germany; Faculty of Biology (K.M.), Medicine and Health, University of Manchester, Manchester, United Kingdom., Iester M; DiNOGMI (C.A.C., M.I., C.E.T.), Università di Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino (C.A.C., M.I., C.E.T.), Genova, Italy., Traverso CE; DiNOGMI (C.A.C., M.I., C.E.T.), Università di Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino (C.A.C., M.I., C.E.T.), Genova, Italy., Di Maita M; Department of Ophthalmology (M.D.M.), Policlinico G.B. Morgagni, Catania, Italy., Li Calzi G; Department of Ophthalmology (M.S., G.L.C., P.N.), San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy., Nucci P; Department of Ophthalmology (M.S., G.L.C., P.N.), San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy., Bandello F; Department of Ophthalmology (R.T., P.B., C.C., F.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy., Triolo G; Department of Ophthalmology (G.T.), Fatebenefratelli and Ophthalmic Hospital, ASST-Fatebenefratelli-Sacco, Milan, Italy., De Cillà S; From the Department of Ophthalmology (A.R., P.D., A.C., S.D.C.), University Hospital Maggiore della Carità, Novara, Italy; Department of Health Sciences (A.R., S.D.C.), Università del Piemonte Orientale 'Amedeo Avogadro', Novara, Italy.
Jazyk: angličtina
Zdroj: American journal of ophthalmology [Am J Ophthalmol] 2024 Mar; Vol. 259, pp. 117-130. Date of Electronic Publication: 2023 Nov 17.
DOI: 10.1016/j.ajo.2023.11.011
Abstrakt: Purpose: To evaluate risk factors for failure of Microshunt in glaucoma patients.
Design: Multicenter retrospective cohort study.
Methods: The study included 220 eyes from 220 consecutive glaucoma patients undergoing Microshunt implantation at six glaucoma units. Four intraocular pressure (IOP) success criteria were defined: (A) IOP ≤21 mm Hg with ≥20% IOP reduction; (B) IOP ≤18 mm Hg with ≥20% IOP reduction; (C) IOP ≤15 mm Hg with ≥25% IOP reduction; and (D) IOP ≤12 mm Hg with ≥30% IOP reduction from baseline. Kaplan-Meier analysis was used to estimate success rates according to the criteria above, and multivariable Cox models were used to identified risk factors for failure according to criterion A.
Results: Success rates varied based on different criteria, ranging from 43.3% to 62.5% (overall success for criteria D and A, respectively) and from 35.3% to 44.4% (complete success for criteria D and A, respectively) at 1-year follow-up. Higher intraoperative MMC concentration was associated with reduced risk of failure to maintain complete (0.4 vs 0.2 mg/mL: hazard ratio [HR] = 0.441, P < .001) and overall (0.4 vs 0.2 mg/mL: HR = 0.360, P = .004) success. For complete success, other risk factors for failure were pseudoexfoliation glaucoma/pigmentary glaucoma (HR = 1.641, P = .004), primary angle closure glaucoma (HR = 1.611, P < .001), and previous non-glaucomatous ocular surgeries (HR = 2.301, P = .002). For overall success, other risk factors for failure were lower preoperative IOP (for 1-mm Hg increase, HR = 0.934, P = .005), higher number of preoperative antiglaucoma agents (HR = 1.626, P < .001), and Microshunt combined with cataract surgery (HR = 1.526, P = .033).
Conclusions: This study identified risk factors for Microshunt failure, highlighting the importance of high intraoperative MMC dose and careful patient selection to optimize surgical success.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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