Impact of glaucoma medications on subsequent Schlemm's canal surgery outcome: Cox proportional hazard model and propensity score‐matched analysis
Purpose The impact of various preoperative glaucoma medications on Schlemm's canal surgery outcomes remains unclear. This study aimed to investigate the impact of preoperative glaucoma medications on the postoperative 1‐year outcomes of μTLO. Methods We analyzed the medical records of 218 patie...
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| Veröffentlicht in: | Acta ophthalmologica (Oxford, England) England), 2024-03, Vol.102 (2), p.e178-e184 |
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| container_title | Acta ophthalmologica (Oxford, England) |
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| creator | Okuda‐Arai, Mina Mori, Sotaro Takano, Fumio Ueda, Kaori Sakamoto, Mari Yamada‐Nakanishi, Yuko Nakamura, Makoto |
| description | Purpose
The impact of various preoperative glaucoma medications on Schlemm's canal surgery outcomes remains unclear. This study aimed to investigate the impact of preoperative glaucoma medications on the postoperative 1‐year outcomes of μTLO.
Methods
We analyzed the medical records of 218 patients who underwent their first μTLO to investigate the 1‐year postoperative outcomes. Cox proportional hazard regression analysis was performed with surgical failure as the dependent variable and each type of preoperative medication as the independent variable. We also compared the 1‐year outcomes of μTLO between users and non‐users of specific medications using propensity score matching. Surgical success was defined as a postoperative intraocular pressure ranging from 5 to 21 mmHg, a ≥20% reduction in IOP from baseline, and no additional glaucoma surgery within 1 year postoperatively.
Results
The Cox proportional hazard analysis showed that all drugs that do not increase the conventional outflow exhibited hazard ratios greater than 1.0, and the preoperative use of β‐blockers and oral CAI was a significant surgical risk factor (hazard ratio: 2.65 and 2.45, p = 0.04 and |
| doi_str_mv | 10.1111/aos.15750 |
| format | Article |
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The impact of various preoperative glaucoma medications on Schlemm's canal surgery outcomes remains unclear. This study aimed to investigate the impact of preoperative glaucoma medications on the postoperative 1‐year outcomes of μTLO.
Methods
We analyzed the medical records of 218 patients who underwent their first μTLO to investigate the 1‐year postoperative outcomes. Cox proportional hazard regression analysis was performed with surgical failure as the dependent variable and each type of preoperative medication as the independent variable. We also compared the 1‐year outcomes of μTLO between users and non‐users of specific medications using propensity score matching. Surgical success was defined as a postoperative intraocular pressure ranging from 5 to 21 mmHg, a ≥20% reduction in IOP from baseline, and no additional glaucoma surgery within 1 year postoperatively.
Results
The Cox proportional hazard analysis showed that all drugs that do not increase the conventional outflow exhibited hazard ratios greater than 1.0, and the preoperative use of β‐blockers and oral CAI was a significant surgical risk factor (hazard ratio: 2.65 and 2.45, p = 0.04 and <0.001). In the propensity score matching analysis, success rates at 1 year postoperatively were 55/85, 54/79, 60/73, and 40/76% for users/non‐users of β‐blockers, topical CAIs, an alpha‐2 adrenergic agonist, and an oral CAI, respectively. Kaplan–Meier survival curves in these comparisons also demonstrated that preoperative β‐blockers and oral CAI use were significant surgical risks (p = 0.01, <0.001).
Conclusion
Our study suggests that preoperative medications that do not involve conventional pathway outflow have a detrimental effect on subsequent Schlemm's canal surgery outcomes.</description><identifier>ISSN: 1755-375X</identifier><identifier>EISSN: 1755-3768</identifier><identifier>DOI: 10.1111/aos.15750</identifier><identifier>PMID: 37698020</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Canals (anatomy) ; conventional pathway ; Glaucoma ; Glaucoma - surgery ; Glaucoma, Open-Angle - surgery ; Humans ; Intraocular Pressure ; Medical records ; microhook ab interno trabeculotomy ; Propensity Score ; Proportional Hazards Models ; Risk factors ; Schlemm's Canal ; Schlemm's canal surgery ; Surgery ; Surgical outcomes ; Sympathomimetics ; Trabeculectomy</subject><ispartof>Acta ophthalmologica (Oxford, England), 2024-03, Vol.102 (2), p.e178-e184</ispartof><rights>2023 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd</rights><rights>2023 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2024 Acta Ophthalmologica Scandinavica Foundation</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3480-d3993259042c6afa6502616d9c48167cf6c3ad4e18e7f0c452867eee320c96473</cites><orcidid>0000-0002-6464-4302 ; 0000-0003-1991-3232 ; 0000-0003-0370-2190</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Faos.15750$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Faos.15750$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37698020$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Okuda‐Arai, Mina</creatorcontrib><creatorcontrib>Mori, Sotaro</creatorcontrib><creatorcontrib>Takano, Fumio</creatorcontrib><creatorcontrib>Ueda, Kaori</creatorcontrib><creatorcontrib>Sakamoto, Mari</creatorcontrib><creatorcontrib>Yamada‐Nakanishi, Yuko</creatorcontrib><creatorcontrib>Nakamura, Makoto</creatorcontrib><title>Impact of glaucoma medications on subsequent Schlemm's canal surgery outcome: Cox proportional hazard model and propensity score‐matched analysis</title><title>Acta ophthalmologica (Oxford, England)</title><addtitle>Acta Ophthalmol</addtitle><description>Purpose
The impact of various preoperative glaucoma medications on Schlemm's canal surgery outcomes remains unclear. This study aimed to investigate the impact of preoperative glaucoma medications on the postoperative 1‐year outcomes of μTLO.
Methods
We analyzed the medical records of 218 patients who underwent their first μTLO to investigate the 1‐year postoperative outcomes. Cox proportional hazard regression analysis was performed with surgical failure as the dependent variable and each type of preoperative medication as the independent variable. We also compared the 1‐year outcomes of μTLO between users and non‐users of specific medications using propensity score matching. Surgical success was defined as a postoperative intraocular pressure ranging from 5 to 21 mmHg, a ≥20% reduction in IOP from baseline, and no additional glaucoma surgery within 1 year postoperatively.
Results
The Cox proportional hazard analysis showed that all drugs that do not increase the conventional outflow exhibited hazard ratios greater than 1.0, and the preoperative use of β‐blockers and oral CAI was a significant surgical risk factor (hazard ratio: 2.65 and 2.45, p = 0.04 and <0.001). In the propensity score matching analysis, success rates at 1 year postoperatively were 55/85, 54/79, 60/73, and 40/76% for users/non‐users of β‐blockers, topical CAIs, an alpha‐2 adrenergic agonist, and an oral CAI, respectively. Kaplan–Meier survival curves in these comparisons also demonstrated that preoperative β‐blockers and oral CAI use were significant surgical risks (p = 0.01, <0.001).
Conclusion
Our study suggests that preoperative medications that do not involve conventional pathway outflow have a detrimental effect on subsequent Schlemm's canal surgery outcomes.</description><subject>Canals (anatomy)</subject><subject>conventional pathway</subject><subject>Glaucoma</subject><subject>Glaucoma - surgery</subject><subject>Glaucoma, Open-Angle - surgery</subject><subject>Humans</subject><subject>Intraocular Pressure</subject><subject>Medical records</subject><subject>microhook ab interno trabeculotomy</subject><subject>Propensity Score</subject><subject>Proportional Hazards Models</subject><subject>Risk factors</subject><subject>Schlemm's Canal</subject><subject>Schlemm's canal surgery</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Sympathomimetics</subject><subject>Trabeculectomy</subject><issn>1755-375X</issn><issn>1755-3768</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc1u1TAQhS0Eoj-w4AWQJRaUxW3t-Cdxd9VVgUqVuihI7KKpM-lNFccXTyIIqz4CEm_Ik-DbW7qo1Nl4pPPN0YwPY2-kOJS5jiDSoTSlEc_YriyNWajSVs8fevNth-0R3QhhpbX6JdvJuqtEIXbZn7OwBj_y2PLrHiYfA_CATedh7OJAPA6cpivC7xMOI7_0qx5DeE_cwwB9ltI1ppnHacyTeMyX8Sdfp7iOaTOeiRX8gtTwEBvsOQzNnYoDdePMyceEf29_Bxj9Chu-sZypo1fsRQs94ev7d599_Xj6Zfl5cX7x6Wx5cr7wSldi0SjnVGGc0IW30II1osgHNs7rStrSt9YraDTKCstWeG2KypaIqArhndWl2mcHW9-8U76Pxjp05LHvYcA4UZ15LU2lSpHRd4_QmzilvG-mXGF0oZx1mfqwpXyKRAnbep26AGmupag3SdU5qfouqcy-vXecrvKHP5D_o8nA0Rb40fU4P-1Un1xcbi3_AfVdoDM</recordid><startdate>202403</startdate><enddate>202403</enddate><creator>Okuda‐Arai, Mina</creator><creator>Mori, Sotaro</creator><creator>Takano, Fumio</creator><creator>Ueda, Kaori</creator><creator>Sakamoto, Mari</creator><creator>Yamada‐Nakanishi, Yuko</creator><creator>Nakamura, Makoto</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6464-4302</orcidid><orcidid>https://orcid.org/0000-0003-1991-3232</orcidid><orcidid>https://orcid.org/0000-0003-0370-2190</orcidid></search><sort><creationdate>202403</creationdate><title>Impact of glaucoma medications on subsequent Schlemm's canal surgery outcome: Cox proportional hazard model and propensity score‐matched analysis</title><author>Okuda‐Arai, Mina ; Mori, Sotaro ; Takano, Fumio ; Ueda, Kaori ; Sakamoto, Mari ; Yamada‐Nakanishi, Yuko ; Nakamura, Makoto</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3480-d3993259042c6afa6502616d9c48167cf6c3ad4e18e7f0c452867eee320c96473</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Canals (anatomy)</topic><topic>conventional pathway</topic><topic>Glaucoma</topic><topic>Glaucoma - surgery</topic><topic>Glaucoma, Open-Angle - surgery</topic><topic>Humans</topic><topic>Intraocular Pressure</topic><topic>Medical records</topic><topic>microhook ab interno trabeculotomy</topic><topic>Propensity Score</topic><topic>Proportional Hazards Models</topic><topic>Risk factors</topic><topic>Schlemm's Canal</topic><topic>Schlemm's canal surgery</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>Sympathomimetics</topic><topic>Trabeculectomy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Okuda‐Arai, Mina</creatorcontrib><creatorcontrib>Mori, Sotaro</creatorcontrib><creatorcontrib>Takano, Fumio</creatorcontrib><creatorcontrib>Ueda, Kaori</creatorcontrib><creatorcontrib>Sakamoto, Mari</creatorcontrib><creatorcontrib>Yamada‐Nakanishi, Yuko</creatorcontrib><creatorcontrib>Nakamura, Makoto</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Acta ophthalmologica (Oxford, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Okuda‐Arai, Mina</au><au>Mori, Sotaro</au><au>Takano, Fumio</au><au>Ueda, Kaori</au><au>Sakamoto, Mari</au><au>Yamada‐Nakanishi, Yuko</au><au>Nakamura, Makoto</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of glaucoma medications on subsequent Schlemm's canal surgery outcome: Cox proportional hazard model and propensity score‐matched analysis</atitle><jtitle>Acta ophthalmologica (Oxford, England)</jtitle><addtitle>Acta Ophthalmol</addtitle><date>2024-03</date><risdate>2024</risdate><volume>102</volume><issue>2</issue><spage>e178</spage><epage>e184</epage><pages>e178-e184</pages><issn>1755-375X</issn><eissn>1755-3768</eissn><abstract>Purpose
The impact of various preoperative glaucoma medications on Schlemm's canal surgery outcomes remains unclear. This study aimed to investigate the impact of preoperative glaucoma medications on the postoperative 1‐year outcomes of μTLO.
Methods
We analyzed the medical records of 218 patients who underwent their first μTLO to investigate the 1‐year postoperative outcomes. Cox proportional hazard regression analysis was performed with surgical failure as the dependent variable and each type of preoperative medication as the independent variable. We also compared the 1‐year outcomes of μTLO between users and non‐users of specific medications using propensity score matching. Surgical success was defined as a postoperative intraocular pressure ranging from 5 to 21 mmHg, a ≥20% reduction in IOP from baseline, and no additional glaucoma surgery within 1 year postoperatively.
Results
The Cox proportional hazard analysis showed that all drugs that do not increase the conventional outflow exhibited hazard ratios greater than 1.0, and the preoperative use of β‐blockers and oral CAI was a significant surgical risk factor (hazard ratio: 2.65 and 2.45, p = 0.04 and <0.001). In the propensity score matching analysis, success rates at 1 year postoperatively were 55/85, 54/79, 60/73, and 40/76% for users/non‐users of β‐blockers, topical CAIs, an alpha‐2 adrenergic agonist, and an oral CAI, respectively. Kaplan–Meier survival curves in these comparisons also demonstrated that preoperative β‐blockers and oral CAI use were significant surgical risks (p = 0.01, <0.001).
Conclusion
Our study suggests that preoperative medications that do not involve conventional pathway outflow have a detrimental effect on subsequent Schlemm's canal surgery outcomes.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>37698020</pmid><doi>10.1111/aos.15750</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-6464-4302</orcidid><orcidid>https://orcid.org/0000-0003-1991-3232</orcidid><orcidid>https://orcid.org/0000-0003-0370-2190</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Acta ophthalmologica (Oxford, England), 2024-03, Vol.102 (2), p.e178-e184 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Canals (anatomy) conventional pathway Glaucoma Glaucoma - surgery Glaucoma, Open-Angle - surgery Humans Intraocular Pressure Medical records microhook ab interno trabeculotomy Propensity Score Proportional Hazards Models Risk factors Schlemm's Canal Schlemm's canal surgery Surgery Surgical outcomes Sympathomimetics Trabeculectomy |
| title | Impact of glaucoma medications on subsequent Schlemm's canal surgery outcome: Cox proportional hazard model and propensity score‐matched analysis |
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