激光房角穿刺对非穿透小梁手术后高眼压的治疗

目的评价激光房角穿刺治疗非穿透小梁手术后眼压升高的临床疗效和安全性。方法以21例（23眼）开角型青光眼患者为研究对象作前瞻性研究，当非穿透小梁手术后眼压〉21mmHg时，即在手术部位行Nd：YAG激光房角穿刺。结果激光前平均眼压（25．1±2．4）mmHg，房角穿刺后1h的平均眼压降至（14．2±3．9）mmHg（P〈0．01）。激光后随访（10．5±4．1）个月，最后一次随访的平均眼压为（16．0±3．6）mmHg（P〈0．01）。并发症为浅前房、脉络膜脱离1眼，虹膜周边前粘连1眼。结论Nd：YAG激光房角穿刺能有效和安全地治疗非穿透小梁手术后小梁网-后弹力膜的房水低滤过状态，降低再次手术率。     

激光虹膜周边切除与虹膜周边成形治疗早期闭角型青光眼的临床观察

目的观察激光虹膜周边切除术和激光虹膜周边成形术对早期原发性闭角型青光眼的疗效。方法30名（50眼）早期闭角型青光眼的患者，按照UBM检查分组：虹膜膨隆型眼做Q开关Nd：YAG激光虹膜周边切除术（A组，18人，31眼）；虹膜高褶型眼做倍频Nd：YAG激光虹膜周边成形术（B组，12人，19眼）；激光术后1月停用降眼压眼液，前房角开放度无明显增加，并且眼压≥21mmHg者，改做激光虹膜周边切除术或激光虹膜周边成形术（C组，8人，10眼）。结果术后3个月30名患者的平均眼压和平均用药指数从术前的（21．8±3．1）mmHg和2．6±1．4降到（17．8±1．6）mmHg和1．0±0．90。A、B、C三组术后小梁虹膜夹角分别增加了10°、9°、11°，房角开放距离（AOD500）分别增加了0．17mm，0．19mm，0．22mm，差异均有非常显著意义（p〈0．01）。A、B、C三组术后瞳孔增大者分别为16％、53％、50％，视力下降者分别为13％、32％、30％。3组间比较，术后视力的变化差异无显著性（P〉0．05），术后瞳孔的变化差异有显著性（P〈0．05）。结论激光虹膜周边成形术对根部虹膜高褶的青光眼疗效较好。激光虹膜周边切除术对虹膜膨隆型青光眼疗效较好。对1种激光疗法效果不佳者可联合2种激光治疗。     

非穿透小梁切除联合羊膜植入治疗原发性开角型青光眼

目的：评估非穿透小梁切除术联合丝裂霉素处理的羊膜植入术治疗原发性开角型青光眼的临床疗效。 方法：原发性开角型青光眼患者40例58眼行非穿透小梁切除术联合丝裂霉素处理的羊膜植入术,术后进行6~18mo随访,对患者的眼压、视力以及滤过泡情况进行观察。 结果：手术后患者的眼压控制良好,术后的视力与术前比较没有显著的变化,而术后18mo的平均眼压（17.6±45mmHg）和术前的平均眼压（35.3±6.8mmHg）对比,差异有统计学意义（t=16.531,P<0.05）。在随访期间有27眼（46.55%）患者有功能性滤过泡,需用药物治疗者5眼。9眼（15.52%）患者滤过泡有苍白局限化,表现出贫血状。 结论：非穿透小梁切除术联合丝裂霉素处理的羊膜植入术治疗原发性开角型青光眼可以有效地降低眼压,临床疗效良好。     

选择性激光小梁成形术治疗原发性青光眼

目的评价选择性激光小梁成形术治疗原发性开角型青光眼(primaryopenangleglaucome,POAG)及原发性闭角型青光眼(prionaryangleclosureglaucome,PACG)虹膜周切术后残余青光眼的疗效和安全性。方法前瞻性、非随机性选择局部用药眼压不能控制的原发性开角型青光眼患者(13例16眼),或已行周边虹膜切除或激光虹膜打孔术,房角大部开放而眼压高的原发性闭角型青光眼患者(22例32眼)。应用选择性激光小梁成形术治疗。观察患者术后6个月眼压的变化。结果两组患者的眼压在激光治疗后均有显著下降:POAG组由术前的(25.3±3.9)mmHg降低至术后6个月的(18.0±4.2)mmHg;PACG组由术前的(23.9±3.0)mmHg,降低至术后6个月的(18.8±3.8)mmHg(1kPa=7.5mmHg)。术后暂时的眼压升高为最常见的并发症。结论选择性激光小梁成形术不仅可用于原发性开角型青光眼的治疗,也可以作为治疗残余闭角型青光眼的一种安全有效的方法。     

准分子激光治疗原发性青光眼的临床观察

目的　探讨准分子激光治疗原发性青光眼的效果。　方法　原发性青光眼 5 7眼 ,其中 5 0眼为开角型青光眼 ,7眼为闭角型青光眼 ,用ArF准分子激光行巩膜瓣下巩膜造瘘。　结果　 5 7眼术前平均眼压 (33 2 3± 18 45 )mmHg ,术后平均 (15 2 3± 6 45 )mmHg。治疗前后眼压具有显著性差异 (P <0 0 0 1)。 5眼闭角型青光眼术后眼压波动较大 ,其中 2眼改行小梁切除术。术后视力保持或改善占 87 7% ,前房深度、视野及视杯无明显改变 ,无 1例出现较严重的术后并发症。　结论　准分子激光巩膜瓣下巩膜造瘘是一种治疗原发性开角型青光眼的行之有效的手术方法。     

非穿透小梁手术联合丝裂霉素C治疗开角型青光眼

目的探讨非穿透小梁手术联合丝裂霉素C治疗开角型青光眼的临床疗效。方法对22例26眼原发性开角型青光眼行非穿透小梁手术,术中联合应用丝裂霉素C,术后观察视功能、眼压、滤过泡、前房角等情况,随访时间6～24个月,平均14个月。结果术后1周及3个月、6个月视力较术前无下降,术后1周平均眼压11.3±6.79mmHg,6个月平均眼压13.7±5.78mmHg,与术前26.24±7.92mmHg比较,差异有显著性。术后无严重并发症。结论非穿透小梁手术联合丝裂霉素C对患眼视功能影响小,降眼压效果确定,并发症少,是治疗原发性开角型青光眼的可行方法。     

Schlemm管为基础的青光眼内引流手术术后眼压分布特征

目的：分析以Schlemm管为基础的各类型青光眼内引流手术术后眼压分布特征。方法：回顾性系列病例研究。选取2015年6月至2019年1月于温州医科大学附属眼视光医院行以Schlemm管为基础的青光眼内引流手术（黏小管成形术和穿透性黏小管成形术）的患者资料,入选其中随访时间≥6个月, 且末次随访在未用药情况下眼压≤21 mmHg（1 mmHg=0.133 kPa）患者,分析患者的眼压分布特征。各类型青光眼的眼压比较采用单因素方差分析。结果：共纳入患者204例（236眼）,术前眼压为 （33.4±12.1）mmHg,用药（2.7±1.2）种。术后末次随访时（6个月及以上）眼压为（13.9±3.3）mmHg。 其中眼压分布在5～10 mmHg有37眼（15.7%）,分布在>10～12 mmHg有43眼（18.2%）,分布在 >12～15 mmHg有78眼（33.1%）,分布在>15～18 mmHg有56眼（23.7%）,分布在>18～21 mmHg有 22眼（9.3%）。原发性开角型青光眼（85眼）、原发性闭角型青光眼（30眼）、继发性青光眼（76眼）和先天性青光眼（45眼）的末次随访眼压分别为（13.9±3.2）（14.5±3.0）（14.0±3.3）（13.2±3.7）mmHg, 各类型青光眼总体眼压差异无统计学意义（F=1.011,P=0.289）。对于原发性开角型青光眼,早、中、 晚期青光眼的目标眼压达标率分别为82.4%、81.8%、36.8%。结论：以Schlemm管为基础的青光眼内引流手术术后平均眼压为14 mmHg,80%的早、中期以及1/3的晚期原发性开角型青光眼患者可以达到目标眼压。     

隧道式小切口小梁切除术治疗青光眼的临床观察

目的观察隧道式小切口小梁切除术治疗青光眼的临床效果。方法对年龄大于40岁的原发性闭角型青光眼及开角型青光眼33例40眼,分别行隧道式小切口小梁切除术（改良组：16例20眼）和标准小梁切除术（对照组：17例20眼）,并随访12个月,比较2种手术前后眼压、手术成功率、术后滤过泡形成和并发症情况。结果2组术后5d、12个月的平均眼压：改良组（11.47±3.08）mmHg（1kPa=7.5mmHg）、（15.80±2.81）mmHg;对照组（11.32±2.53）mm-Hg、（15.15±2.67）mmHg,均明显低于术前改良组（25.88±12.02）mmHg（P〈0.001、0.01）;对照组（22.58±12.52）mmHg（P〈0.01、0.05）。2组间术前、术后5d、12个月的平均眼压,以及术后12个月的手术成功率（改良组80%、对照组75%）、术后功能滤过泡占各组总例数的比率（改良组85%、对照组75%）和术后并发症发生率（改良组25%、对照组30%）比较,差异均无统计学意义（P〉0.05）。结论与标准小梁切除术相比,隧道式小切口小梁切除术效果相同,小切口使术式更安全便捷,且减少了对结膜筋膜囊的损伤。     

非穿透性小梁切除联合丝裂霉素术后眼压日曲线的变化

目的观察原发性开角型青光眼非穿透性小梁切除术联合应用丝裂霉素的临床疗效及眼压日曲线变化。方法26例（26眼）原发性开角型青光眼行非穿透性小梁切除联合术中应用丝裂霉素,术后随访1年,观察术后眼压控制情况、眼压日曲线变化、峰谷眼压差值,视力、滤过泡、视野等情况。结果术前平均眼压（25．2±3．4）mmHg（1mmHg=0．133kPa）,峰值眼压（34．7±4．3）mm—Hg,谷值眼压（15．5±3．1）mmHg,眼压波动值（19．2±3．3）mmHg;术后平均眼压（15．1±2．5）mmHg,峰值眼压（19．7±3．6mmHg）,谷值眼压（10．4±2．8）mmHg,眼压波动值（9．3±2．2）mmHg,手术前后的平均眼压、峰值眼压、谷值眼压、眼压波动值的差异均有统计学意义。手术后平均眼压降低,眼压曲线峰谷差值缩小,眼压曲线趋于平稳。结论原发性开角型青光眼行非穿透性小梁切除联合丝裂霉素术后眼压控制较好,手术安全性较好,眼压日曲线峰谷差值缩小,近期效果较好,远期效果有待进一步观察。     

视觉诱发电位对青光眼和高眼压的意义

用图象视觉诱发电位(P-VEP)检测了414眼,分成3组:Ⅰ组为164眼原发性开角型青光眼,眼压超过22mmHg,伴有青光眼性视野缺损和病理性视盘凹陷,平均年龄58.69±9.6岁,Ⅱ组为168眼高眼压,眼压超过22mmHg,但不伴有视野和视盘的改变,平均年龄50.64±13.2岁;Ⅲ组为82只正常眼,平均年龄48.5±     

Primary viscocanalostomy versus trabeculectomy for primary open-angle glaucoma: three-year prospective randomized clinical trial

PURPOSE: To compare the efficacy and safety of viscocanalostomy and trabeculectomy in patients with primary open-angle glaucoma (POAG). SETTING: Department of Ophthalmology, Ankara Education and Research Hospital, Ankara, Turkey. METHODS: In this prospective randomized trial, 50 eyes of 50 patients with medically uncontrolled POAG were randomized to have a trabeculectomy (25 eyes) or a viscocanalostomy (25 eyes). Visual acuity, intraocular pressure (IOP), and slitlamp examinations were performed before surgery and 1 day, 1 week, 1, 3, and 6 months, and 1, 2, and 3 years postoperatively. RESULTS: At 3 years, the mean IOP was 16.0 mmHg +/- 7.07 (SD) in the trabeculectomy group and 17.8 +/- 4.6 mmHg in the viscocanalostomy group (P=.694). Complete success (IOP 6 to 21 mm Hg without medication) was achieved in 66.2% of eyes at 6 months and 55.1% at 3 years in the trabeculectomy group and in 52.9% and 35.3%, respectively, in the viscocanalostomy group (P>.05). Qualified success (IOP 6 to 21 mmHg with medication) was achieved in 95.8% of eyes at 6 months and 79.2% at 3 years in the trabeculectomy group and in 90.7% and 73.9%, respectively, in the viscocanalostomy group (P>.05). Postoperative hypotony and cataract formation occurred more frequently in the trabeculectomy group than in the viscocanalostomy group (P=.002). CONCLUSIONS: Primary trabeculectomy lowered IOP more than viscocanalostomy in POAG patients. However, the complication rate was lower in the viscocanalostomy group.     

A randomised, prospective study comparing trabeculectomy with viscocanalostomy with adjunctive antimetabolite usage for the management of open angle glaucoma uncontrolled by medical therapy

AIMS: To compare trabeculectomy with viscocanalostomy augmented with adjunctive antimetabolite use for the control of intraocular pressure (IOP) in open angle glaucoma (OAG). METHODS: 45 patients (50 eyes) with uncontrolled OAG were randomised to either trabeculectomy (25 eyes) or a viscocanalostomy technique (25 eyes). Preoperatively, all eyes were graded in terms of risk factors for drainage failure and were given intraoperative antimetabolites (5-fluorouracil 25 mg/ml (5-FU), mitomycin C (MMC) 0.2 mg/ml and 0.4 mg/ml) according to a standard protocol. RESULTS: There were no significant differences between the groups in age, sex, type of OAG, preoperative medications, risk factors for drainage failure, and preoperative IOP. Mean follow up was 20 months (range 3-24 months). It was 12 months or longer in all eyes, except two lost to follow up at 3 months. At 12 months, complete success (IOP<21 mm Hg without antiglaucoma medications) was seen in 91% of eyes undergoing trabeculectomy, but in only 60% of eyes undergoing viscocanalostomy (p<0.02). Similarly, at the last follow up visit (mean 20 months) complete success was seen in 68% of eyes undergoing trabeculectomy and 34% with viscocanalostomy (p<0.05). In terms of qualified success (IOP<21 mm Hg with or without glaucoma medications) and mean IOP measurements postoperatively there were no difference between the groups, although the mean number of antiglaucomatous medications required postoperatively was less with trabeculectomy (0.39) than viscocanalostomy (1.04) (p<0.05). Needling procedures were more commonly required after trabeculectomy (p<0.02). YAG goniotomy was required in three eyes (13%) after viscocanalostomy. Early transient complications such as anterior chamber shallowing and encysted blebs were more common in the trabeculectomy group (p<0.05). Late postoperative cataract formation was similar between the two groups. CONCLUSION: In terms of complete success and number of antiglaucomatous medications required postoperatively, IOP control appears to be better with trabeculectomy. Viscocanalostomy is associated with fewer early transient postoperative complications.     

Nonpenetrating deep sclerectomy with reticulated hyaluronic acid implant versus punch trabeculectomy: a prospective clinical trial

PURPOSE: To compare the intraocular pressure (IOP)-lowering effect and complication rate of nonpenetrating deep sclerectomy (NPDS) with reticulated hyaluronic acid (SK-GEL) scleral implant versus traditional punch trabeculectomy (PT) in the management of primary open angle glaucoma (POAG). METHODS: Prospective, randomized comparative study including 93 patients with uncontrolled POAG. Group 1 (43 eyes) underwent NPDS with SK-GEL scleral implant; Group 2 (50 eyes) underwent PT. Mitomycin C (0.2 mg/mL) was applied intraoperatively in both techniques. Study follow-up evaluations were conducted at 36 and 48 months. Complete success indicated the achievement of the target IOP without antiglaucoma medications, while qualified success indicated the same goal with medications. These categories were assessed at two target IOP levels, <21 mmHg and <18 mmHg. RESULTS: At 36 months for complete and qualified success with a <21 and <18 mmHg target IOP, no significant differences were noted between the two groups. At 48 months postprocedure when a <21 mmHg IOP target was considered, the rate of eyes that achieved complete success was 51.1% in the NPDS group versus 72% in the PT group (p<0.05). As for the <18 mmHg IOP target, the rate of eyes that achieved complete success was 32.5% in the NPDS group versus 44% in the PT group (p<0.05). Complications occurred significantly more frequently after PT than after NPDS. CONCLUSIONS: The IOP-lowering effects of the two procedures were comparable at 36 months. At 48 months PT showed a significantly higher rate of complete success compared with NPDS. Complications were more frequent after PT than after NPDS.     

Trabeculectomy with beta radiation: long-term follow-up

PURPOSE: To evaluate the long-term outcome and complications of trabeculectomy with beta radiation. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Forty-three patients with confirmed primary open-angle glaucoma (POAG), who received trabeculectomy with adjunctive beta radiation at the Prince of Wales Hospital between June 1991 and November 1994. METHODS: Patients fulfilling the preceding criteria were followed up longitudinally. The visual acuity, intraocular pressure (IOP), bleb morphology, and complications were evaluated. MAIN OUTCOME MEASURES: Visual acuity, IOP, bleb morphology, complications. RESULTS: Forty-three eyes of 43 consecutive Chinese patients were recruited and successfully followed up for a minimum of 7 years. The mean age +/- 1 standard deviation (SD) was 60.9 +/- 13.0 years. There were 29 males and 14 females. The mean baseline IOP +/- 1 SD was 28.3 +/- 5.8 mmHg. The mean postoperative IOP +/- 1 SD after the initial trabeculectomy was 11.9 +/- 4.3 mmHg, and the mean number of preoperative IOP-lowering eyedrops +/- 1 SD was reduced from 2.8 +/- 0.5 to 0.7 +/- 1.0 at 7 years follow-up. The qualified success rate at 7 years follow-up, defined as IOP 相似文献   

Viscocanalostomy versus trabeculectomy in white adults affected by open-angle glaucoma: a 2-year randomized,controlled trial

PURPOSE: To compare the effectiveness and safety of viscocanalostomy and trabeculectomy in adults with uncontrolled open-angle glaucoma. DESIGN: Single-masked, parallel-group, prospective, randomized 24-month trial, with 90% power to detect a clinically important difference between groups. PARTICIPANTS: Fifty consecutive patients (50 eyes) with primary open-angle or pseudoexfoliative glaucoma. INTERVENTION: Eyes were assigned randomly to either viscocanalostomy (group 1) or trabeculectomy (group 2) with no intraoperative antifibrotics in the study eye. In group 1, no further intervention was allowed, whereas trabeculectomy eyes could receive subconjunctival 5-fluorouracil (5-FU) injections or laser suture lysis after surgery. MAIN OUTCOME MEASURES: Success rate based on intraocular pressure (IOP), visual acuity, discomfort, and other complications. RESULTS: At the end of the 24-month follow-up, IOP of 21 mmHg or less and more than 6 mmHg was achieved in 76% in group 1 (n = 19) and in 80% in group 2 (n = 20; log-rank P = 0.60); an IOP between 6 and 16 mmHg was obtained in 56% in group 1 (n = 14) and in 72% in group 2 (n = 18; log-rank P = 0.17; Kaplan-Meier cumulative probability of success). Complications of viscocanalostomy included one intraoperative conversion into trabeculectomy; microruptures in Descemet's membrane in five eyes; three cases of iris incarceration in the Decemet's window, two of which caused early failure of the procedure requiring reoperation; and a 1-mm to 2-mm transient self-resolving hyphema in three cases. Complications of trabeculectomy included one case of postoperative bleb bleeding with early transient IOP spike; one early hyphema; five cases of postoperative hypotony, two of which had a positive Seidel test from the conjunctival suture; three cases of transient choroidal detachment, two of which had shallow anterior chamber. No patient required reoperation. Two eyes required argon laser suture lysis, and nine underwent one or more 5-FU injections, which caused punctate keratopathy in three eyes. CONCLUSIONS: Viscocanalostomy is an effective IOP-lowering procedure in white adults affected by open-angle glaucoma. Trabeculectomy with postoperative 5-FU can probably provides lower IOPs but, with more numerous complications, greater discomfort, and more intensive postoperative management.     

Primary viscocanalostomy versus trabeculectomy in white patients with open-angle glaucoma: A randomized clinical trial

PURPOSE: To compare viscocanalostomy, a nonpenetrating procedure for glaucoma treatment, with trabeculectomy. DESIGN: Randomized controlled trial. PARTICIPANTS: Twenty white subjects (20 eyes) with open-angle glaucoma with no history of surgery were enrolled. METHODS: Ten subjects were randomly assigned to viscocanalostomy according to Stegmann's technique and 10 subjects to a modified Cairns trabeculectomy. A complete ophthalmologic examination was performed the day before surgery and postoperatively. Further visits were scheduled monthly for 6 to 8 months after surgery. MAIN OUTCOME MEASURES: Success was defined as intraocular pressure (IOP) between 7 and 20 mmHg, with no medication. RESULTS: After a mean follow-up of 6 months (range, 6-8 months), success was obtained in 5 of 10 cases in the trabeculectomy group and in no case in the viscocanalostomy group. With Kaplan-Meier's method, subjects with viscocanalostomy showed shorter postoperative IOP-reduction periods than subjects undergoing trabeculectomy. CONCLUSIONS: According to the results of this short-term study, trabeculectomy was more effective than viscocanalostomy in lowering IOP in glaucomatous eyes of white patients.     

Long-term outcome of trabeculectomy in terms of intraocular pressure

PURPOSE: To evaluate the outcome, long-term results and contributing prognostic factors of trabeculectomy in terms of intraocular pressure (IOP) and to compare the results in primary open-angle glaucoma (POAG) and exfoliation glaucoma (EG). METHODS: This study involved retrospective evaluation of 138 consecutive patients (138 eyes) with either POAG or EG. All patients had undergone primary trabeculectomy performed by the same surgeon between November 1994 and August 1996. Only one eye per patient was included. Operations performed with the use of antimetabolites were excluded. All patients were aged over 40 years and were white. Follow-up for all subjects lasted at least 2 years. Successful control of IOP was defined as achieving IOP < or = 21 mmHg without medication (complete success) or with a single topical medication (qualified success). Success rates were determined using the Kaplan-Meier survival curve, and risk factors were analysed with proportional hazards regression. RESULTS: According to the Kaplan-Meier survival curve, success rates (complete or qualified) were 82% at 1 year, 70% at 2 years, 64% at 3 years and 52% at 4 years. A total of 63% were complete successes at 1 year, 54% at 2 years, 45% at 3 years and 40% at 4 years. Complete success rates were significantly better in the POAG group than in the EG group. Proportional hazards regression analysis showed that the presence of EG and early postoperative IOP > 30 mmHg decreased the possibility of complete success, while a cataract operation performed during follow-up improved it. CONCLUSION: The IOP-reducing effect of trabeculectomy decreases gradually. After 4 years, 52% of operated eyes had IOP < or = 21 mmHg with or without a single topical medication. Diagnosis of EG implied a worse long-term outcome for trabeculectomy in terms of IOP.     

Long-term results of viscocanalostomy in pseudoexfoliative and primary open angle glaucoma

Purpose: To document the outcome of viscocanalostomy (VC) alone or combined with phacoemulsification (phaco‐VC) in eyes with pseudoexfoliation glaucoma (PEXG) and primary open angle glaucoma (POAG). Methods: A prospective, comparative study of 314 eyes undergoing VC in two centres over 6 years was conducted. Main outcome measures were: (i) intraocular pressure (IOP) control (complete success was IOP ≤ 18 mmHg without medication and failure IOP > 18 mmHg); and (ii) requirement for Nd:YAG laser goniopuncture (YAG‐GP) if IOP > 21 mmHg. Results: In the POAG group, 174 eyes underwent phaco‐VC and 104 VC. In the PEX group, 20 eyes underwent phaco‐VC and 16 VC. At final follow up, complete success rate (CSR) was 76% for POAG phaco‐VC, 67% for POAG VC, 95% for PEXG phaco‐VC and 63% for PEXG VC with mean IOP reduction of 29.9%, 40%, 42.5% and 51%, respectively. Without YAG‐GP, by 3 years postoperatively the failure rate was 100% for PEXG eyes and 21% for POAG eyes undergoing VC alone, but PEXG eyes undergoing phaco‐VC were 100% successful. CSR for YAG‐GP was 92% in PEXG VC eyes and 55% in POAG VC eyes. Conclusions: In phakic eyes with PEXG undergoing VC, an absolute requirement for long‐term success was YAG‐GP. This was not the case in POAG eyes or PEXG eyes undergoing phaco‐VC. Late IOP rise in phakic PEXG eyes and restoration of IOP control following YAG‐GP suggests that continued release of PEX material from the lens capsule with time blocks the outflow through the trabecular‐Descemetic window created by VC.     

超声乳化联合小梁切除术及术中应用5-氟尿嘧啶治疗青光眼合并白内障的长期疗效观察

目的探讨超声乳化联合小梁切除术及术中应用5氟尿嘧啶(5fluorouracil,5Fu)治疗青光眼合并白内障的疗效。方法对1996年1月至1998年12月,在新加坡国立眼科中心行超声乳化联合小梁切除术及术中应用5Fu治疗的71例(71只眼)原发性开角型青光眼(POAG)和原发性闭角型青光眼(PACG)患者的临床资料进行回顾性分析。除外随访时间<6个月的患者。结果术后患者平均眼压和平均用药种数均较术前明显降低,差异有统计学意义(P<001)。术后随访1~5年的患者眼压与术前比较均明显下降,差异有统计学意义(P<001)。手术完全成功率1、3及5年分别为842%、627%及553%。在手术完全成功的条件下,POAG与PACG(P=0281)、同一切口与不同切口(P=0487)手术疗效比较(采用Cox模型进行多因素生存分析),手术成功率差异无统计学意义(P>005)。但POAG与PACG术后平均眼压比较,差异有统计学意义(P=002)。术后较术前平均视力提高差异有统计学意义(P<001)。术后与术前平均视野缺损(MD)值(P=055)和模式标准差(PSD)值(P=064)比较,差异无统计学意义,表明患者术后视野保持稳定。术后4d发生眼内炎1例,术后晚期由于脉络膜渗漏和伤口漏引起低眼压2例。结论超声乳化联合小梁切除术及术中应用5Fu治疗POAG和PACG的成功率高,手术安全,长期观察疗效稳定。POAG与PACG或     

The role of antimetabolites in filtration surgery for neovascular glaucoma: intermediate-term follow-up

PURPOSE: To compare the intermediate-term efficacy of 5-fluorouracil (5-FU) and Mitomycin C (MMC) as adjunctive antimetabolites in neovascular glaucoma (NVG) filtration surgery. METHODS: Forty consecutive eyes of 40 patients with NVG refractory to medical therapy were randomized to receive antimetabolite-augmented trabeculectomy. Eighteen eyes received postoperative 5-FU (5-FU group) and 22 eyes received intraoperative, low-dose (0.2 mg/ml) MMC for 2 mins (MMC group). The main outcome measure was intraocular pressure (IOP). Surgical success was defined as IOP < 21 mmHg with topical treatment (qualified success) or without topical treatment (complete success). Surgical failure was defined as IOP > or = 21 mmHg, despite postoperative topical treatment, and by postoperative blindness. RESULTS: The mean follow-up period was 35.8 +/- 22.6 months in the 5-FU group and 18.6 +/- 17.2 months in the MMC group. This difference was not significant. Mean IOP decreased from 40.4 +/- 10.3 mmHg to 14.7 +/- 3.4 mmHg (p < 0.0001) in the 5-FU group and from 42 +/- 11.3 mmHg to 22.9 +/- 13.3 mmHg (p = 0.0006) in the MMC group; however, the difference between the 5-FU and MMC groups was not significant at any point. The success rate in the 5-FU group was 55.5% (44.4% complete, 11.1% qualified), compared with 54.5% (9.1% complete, 45.4% qualified) in the MMC group. This difference was not significant. CONCLUSIONS: The percentage of patients who achieved postoperative IOP < 21 mmHg was similar in both groups, although a larger proportion of patients treated with MMC-augmented trabeculectomy required topical treatment in comparison with the 5-FU group.