正常眼压性青光眼的药物治疗与手术治疗的比较

目的探讨正常眼压性青光眼(NTG)的药物治疗与手术治疗的疗效。方法对2002年1月至2005年6月已确诊为NTG者,先给予药物治疗半年,对其中视野有进展并且眼压高于14mmHg的17例(30眼),随机分成2组:(1)药物治疗组:以0.5%噻吗心安滴眼,每日2次;(2)手术治疗组:进行小梁切除术。随访时间11～39月。结果治疗后,手术组平均眼压明显低于药物组,差异有统计学意义(P<0.05);两组视野平均缺损(MD值)均较治疗前加重,但视野缺损的进展程度,手术组明显轻于药物组(P<0.05),MD值与眼压存在着明显的相关关系(r=0.76,P<0.01)。结论眼压对NTG的视野改变有直接影响,降低眼压可延缓NTG的进程;而药物降低眼压有一定限度,对药物控制不良或无条件长期随访的患者,建议及时进行抗青光眼手术以降低眼压的治疗。

Comparison of effects of medicine treatment and operation treatment on normal-tension glaucoma (NTG)

Objective To investigate the effects of medicine treatment and operation treatment on normal-tension glaucoma(NTG).Methods Patients were diagnosed NTG between Jan.2002 and Jun.2005 had been firstly treated by medicine for half year.Then 17 cases(30 eyes) with improved visual field loss and intraocular pressure(IOP) higher than 14 mmHg were chosen and divided into medicine treatment group and operation treatment group.For the former group,0.5% timolol was used twice a day all along the treatment period.And for the later group,trabeculectomy was conducted.The follow-up period lasted from 11 months to 39 months.Results After the treatment,the mean IOPs of the operation group were considerably lower than that of medicined treatment group(P<0.05).The mean defects(MD) of visual field of the two group both advanced,but with significantly differences between them(P<0.05).The degree of newly defection in operation group was significantly lower than that in medicine group.There is a definitely relationship between MD and IOP(r=0.75,P<0.01).Conclusions IOPs have direct effects on visual field change.Reducing IOP can slow the progress of NTG.The treatments show that the medicine treatment has a limitation to reduce the IOP.It is suggested that the operation treatment should be taken to reduce the IOP when the medicine can not be taken regularly by the patient or the follow-up can not be carried out for a certain period.