有无急性发作史的慢性闭角型青光眼患者小梁切除术18个月效果比较

目的 比较有无急性发作史的慢性闭角型青光眼（chronic angle closure glaucoma, CACG）患者行小梁切除术后18个月的效果。 设计 前瞻性比较性病例系列。 研究对象  4个临床中心参与的48例（48眼）具有急性发作史的原发性CACG患者（急性发作组）和101例（101眼）无急性发作史的原发性CACG患者（无急性发作组）。方法  所有患者经全面的眼科检查后行小梁切除术，术后随访18个月。记录手术前、手术后1、3天、1、2周、1、3、6、12、18个月的视力、眼压、用药情况及并发症。末次随访时无需使用降眼压药物的情况下眼压小于21 mmHg者认为手术成功。主要指标 眼压、视力变化（末次随访视力-基线视力）、眼压波动（随访中眼压的标准差）和手术成功率。 结果 手术前后视力的变化在急性发作组和无急性发作组分别为-0.06±0.47和0.02±0.36（P=0.166）。随访平均眼压分别为（14.9±4.0） mmHg和（14.6±2.8） mmHg（P=0.601）。随访中的眼压波动分别为（3.1±2.5）mmHg和（2.8±1.6）mmHg（P=0.452）。随访18个月时急性发作组和无急性发作组的眼压分别为（16.8±7.5） mmHg和（15.4±4.0） mmHg（P=0.259）。术后随访18个月急性发作组的手术成功率（85.7%）与无急性发作组的手术成功率（93.1%）的差异无统计学意义（?字2=2.11，P=0.146）。 结论  小梁切除术在有急性发作史和无急性发作史的CACG患者中18个月的手术成功率无明显差异。

Comparison on 18 months results of trabeculetomy for chronic angle closure glaucoma with acute attack to those without acute attack

Objective To compare the 18 months results of initial trabeculectomy in patients with chronic angle closure glaucoma （CACG） with acute attack with those without acute attack. Design Prospective comparative case series. Participants 48 CACG patients with acute attack （48 eyes） （acute attack group） and 101 CACG patients without acute attack （101 eyes） （without acute attack group） from 4 ophthalmic centers were included retrospectively. Methods All patients underwent trabeculetomy and follow-up for 18 months. Visual acuity （VA）, intraocular pressure （lOP）, medication and complications for baseline and postoperation （postoperation 1, 3 days, 1, 2 weeks, 1, 3, 6, 12, 18 months） were recorded. Complete success was defined as IOP was less than 21 mmHg without any medication at the final visit. Main Outcome Measures IOP, changes of VA （VA at final visit-VA at baseline visit）, IOP fluctuation （IOP standard deviation during follow-up）, success rate. Results Change of VA in acute attack group and without acute attack group was -0.06±0.47 and 0.02±0.36, respectively （P=0.166）. Mean IOP during follow-up in acute attack group and without acute attack group was 14.9±4.0 mmHg and 14.6±2.8 mmHg, respectively （P=0.601）. Long term IOP fluctuation was not significantly different between acute attack group and without acute attack group （P=0.452）, which was 3.1±2.5 mmHg and 2.8±1.6 mmHg, respectively. The IOP at postoperation 18 months in acute attack group and without acute acute group was 16.8±7.5 mmHg and 15.4±4.0 mmHg, respectively （P=0.259）. The success rate of the trabeculectomy was better in without acute attack group （93.1%） than that in acute attack group （85.7%）, however, the difference between two groups was not significant （χ^2=2.11, P=0.146）. Conclusion The success rate of the trabeculectomy was similarly high in both acute attack group and without acute attack group.