ABSTRACT

Purpose

To examine patterns of standard (trabeculectomy or glaucoma drainage devices, GDDs) vs novel (minimally invasive glaucoma surgery, MIGS) surgical techniques in the US.

Methods

We used the American Academy of Ophthalmology (AAO) IRIS® Registry (Intelligent Research in Sight) queried between 2013 and 2018 (inclusive) to calculate the cumulative proportion of stand-alone, concurrent (same day) or sequential (subsequent day) glaucoma surgical techniques performed in each glaucoma diagnosis type. Secondary analyses of adjusted proportions of concurrent and sequential surgeries stratified by glaucoma diagnosis were also performed.

Results

Of 203,146 eyes receiving glaucoma surgeries, open angle glaucoma (OAG) was most likely to undergo all types of intervention. The iStent was the most commonly performed MIGS, primarily for those with normal tension glaucoma (NTG) or OAG (p < .001). Conversely, GDD was the most commonly performed procedure in secondary glaucoma or other (specified) glaucoma (p < .001). ECP and iStent were the most common concurrent procedures performed; most often for OAG and NTG (p < .001). After an initial standard surgery, most eyes underwent recurrent standard interventions (90.3%). ECP was the most common MIGS performed after an initial standard surgery; particularly in primary angle-closure (PACG) and secondary glaucoma eyes (p < .001).

Conclusion

Glaucoma type may influence the choice of glaucoma procedures and the decision to perform concurrent as well sequential surgical procedures. Given the poorly understood long term safety and effectiveness of MIGS, and with substantially increasing use of MIGS procedures in recent years, future studies comparing their safety and effectiveness vs standard interventions, for a variety of glaucoma types, is needed.

中文翻译：

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微创青光眼手术 (MIGS) 的使用模式因青光眼类型而异：IRIS 注册分析 2013-2018

摘要

目的

检查美国标准（小梁切除术或青光眼引流装置，GDD）与新型（微创青光眼手术，MIGS）手术技术的模式。

方法

我们使用 2013 年至 2018 年（含）期间查询的美国眼科学会 (AAO) IRIS® Registry（Intelligent Research in Sight）来计算独立、并发（同一天）或序贯（次日）青光眼手术的累积比例在每种青光眼诊断类型中执行的技术。还对按青光眼诊断分层的并发和序贯手术的调整比例进行了二次分析。

结果

在接受青光眼手术的 203,146 只眼睛中，开角型青光眼 (OAG) 最有可能接受所有类型的干预。iStent 是最常执行的 MIGS，主要用于那些患有正常眼压性青光眼 (NTG) 或 OAG 的患者 ( p < .001)。相反，GDD 是继发性青光眼或其他（特定）青光眼中最常执行的手术 ( p < .001)。ECP 和 iStent 是最常见的并发手术；OAG 和 NTG 最常见 ( p < .001)。在初始标准手术后，大多数眼睛接受了复发性标准干预 (90.3%)。ECP 是初始标准手术后最常见的 MIGS；特别是在原发性闭角眼 (PACG) 和继发性青光眼眼中 ( p < .001)。

结论

青光眼类型可能会影响青光眼手术的选择以及同时进行和序贯手术的决定。鉴于对 MIGS 的长期安全性和有效性知之甚少，以及近年来 MIGS 程序的使用大幅增加，未来需要研究比较它们的安全性和有效性与标准干预，用于各种青光眼类型。