Ex-PRESS 与小梁切除术治疗原发性开角型或正常眼压青光眼后的再手术率：日本国家数据库研究,Eye

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Ex-PRESS 与小梁切除术治疗原发性开角型或正常眼压青光眼后的再手术率：日本国家数据库研究
Eye ( IF 2.8 ) Pub Date : 2019-10-23 , DOI: 10.1038/s41433-019-0641-6
Yohei Hashimoto _{1,

2} , Nobuaki Michihata ₃ , Hiroki Matsui ₂ , Kiyohide Fushimi ₄ , Hideo Yasunaga ₂ , Makoto Aihara ₁

Affiliation

目的比较Ex-PRESS植入术与小梁切除术的再手术率。方法我们使用日本的全国住院患者数据库进行了一项回顾性队列研究。纳入 2010 年至 2017 年接受 Ex-PRESS 或小梁切除术的 18-85 岁原发性开角型青光眼或正常眼压青光眼患者。我们使用混合效应 cox 回归模型比较了 Ex-PRESS 和小梁切除术之间的再手术率。协变量是性别、年龄、糖尿病、同时进行白内障手术、眼部手术史和青光眼手术的年度住院人数。此外，我们进行了倾向评分 (PS) 匹配和工具变量 (IV) 分析以确认传统 cox 回归的结果。我们还比较了 PS 匹配组中两种治疗的总住院费用。结果共1027眼行Ex-PRESS，6910眼行小梁切除术。Ex-PRESS 和小梁切除术组的再手术率分别为 7.6% 和 5.8%。两组中最常进行的再手术类型是小梁切除术。混合效应 cox 回归显示，Ex-PRESS 的再手术率显着高于小梁切除术 [调整风险比 (aHR)，1.72；95% 置信区间 (CI)，1.31–2.25；p < 0.001]。PS 和 IV 分析也显示出相似的结果（对于 PS 分析：aHR，2.13；95% CI，1.45–3.13；p < 0.001；对于 IV 分析：aHR，2.26；95% CI，1.05–4.85；p = 0.037） . Ex-PRESS 的总住院费用（7076 美元）显着高于小梁切除术（6223 美元）（p < 0.001）。结论与小梁切除术相比，Ex-PRESS 植入术的再手术率显着提高，费用也更高。

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Reoperation rates after Ex-PRESS versus trabeculectomy for primary open-angle or normal-tension glaucoma: a national database study in Japan

Objective To compare reoperation rates between Ex-PRESS implantation and trabeculectomy. Methods We performed a retrospective cohort study using a national inpatient database in Japan. Patients aged 18–85 years with primary open-angle glaucoma or normal-tension glaucoma who underwent Ex-PRESS or trabeculectomy from 2010 to 2017 were included. We compared the reoperation rates between Ex-PRESS and trabeculectomy using mixed effects cox regression models. Covariates were sex, age, diabetes mellitus, simultaneous cataract surgery, ocular surgical history, and annual hospital volume for glaucoma surgery. Furthermore, we conducted propensity score (PS) matching and instrumental variable (IV) analyses to confirm the results of the conventional cox regression. We also compared total hospitalisation costs between the two treatments in the PS-matched groups. Results In total, 1027 eyes underwent Ex-PRESS and 6910 eyes underwent trabeculectomy. The reoperation rates were 7.6% and 5.8% in the Ex-PRESS and trabeculectomy groups, respectively. The most frequently performed type of reoperation was trabeculectomy in both groups. The mixed effects cox regression showed that Ex-PRESS had significantly higher reoperation rates than trabeculectomy [adjusted hazard ratio (aHR), 1.72; 95% confidence interval (CI), 1.31–2.25; p < 0.001]. The PS and IV analyses also showed similar results (for PS analysis: aHR, 2.13; 95% CI, 1.45–3.13; p < 0.001; for IV analysis: aHR, 2.26; 95% CI, 1.05–4.85; p = 0.037). The total hospitalisation cost of Ex-PRESS (US$7076) was significantly greater than that of trabeculectomy (US$6223) ( p < 0.001). Conclusion Ex-PRESS implantation had significantly higher reoperation rates and greater cost than trabeculectomy.

更新日期：2019-10-23

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