Surgical Results of Trabeculectomy among Groups Stratified by Prostaglandin Associated Periorbitopathy Severity

Ophthalmology Volume 130, Number 3, March 2023

中文摘要

本篇研究的主要目的是探討病人使用Shimane University prostaglandin-associated periorbitopathy
syndrome Grading System (SU-PAP)分級系統，其和青光眼手術（Trabeculectomy）的成效之間是否存在相關性。研究對象為有原發性開放性青光眼、未接受結膜切開手術、完成所有12個月後續追蹤，並利用SU-PAP系統評估其青光眼手術前的病情嚴重程度，共計收集了兩家醫院205例病例，最終納入139位日本患者的眼睛進行分析。研究顯示，手術成果與年齡、性別、手術前眼壓和藥物治療、屈光狀態和是否同時進行白內障手術等因素無關，但是SU-PAP分級系統和手術成效有關。愈厲害的SU-PAP病人的手術成功率較低。研究結果顯示，在進行青光眼手術時，應留意患者的PAP程度，並根據其情況選擇相應治療方式。

English Abstract

The study aimed to evaluate the surgical success rates of trabeculectomy among groups stratified by prostaglandin-associated periorbitopathy (PAP) severity. The Shimane University PAP Grading System (SU-PAP) was used to grade PAP severity among 139 consecutive eyes of 139 Japanese subjects with primary open-angle glaucoma who underwent trabeculectomy between June 2018 and December 2020. The study found that higher SU-PAP grades were associated with lower success rates for intraocular pressure control. Needling, bleb revision, and surgery other than glaucoma were more frequent in patients with higher SU-PAP grades. However, age, gender, preoperative intraocular pressure and medications, refractive error, and simultaneous cataract surgery were not associated with surgical failure. The study suggests that to retain surgical effectiveness, physicians should prevent patients from progressing to severe PAP, an avoidable side effect, by switching or stopping the causative medications. The study also recommends that treating physicians pay attention to patients with severe PAP because it can affect glaucoma management. However, the study acknowledges limitations due to its retrospective design and the potential impact of other glaucoma medications on the results. In conclusion, the study highlights the importance of considering PAP severity when performing trabeculectomy and managing glaucoma.

附註 The SU-PAP grading system classifies the severities of PAP into 4 grades based on the appearance and difficulty performing Goldmann applanation tonometry (GAT).

Grade 0 (no PAP): no prostaglandin-associated cosmetic changes by macroscopic or slit-lamp observation

Grade 1 (superficial cosmetic PAP): the presence of eyelid hyperpigmentation or eyelash growth

Grade 2 (deep cosmetic PAP): the presence of at least 1 of DUES, blepharochalasis
involution, periorbital fat loss, and enophthalmos

Grade 3 (tonometric PAP): difficulty performing GAT or reduced reliability of GAT due to the presence of PAP-related deepening of the upper eyelid sulcus, hardening of eyelids, ptosis, or enophthalmos.