成人开角型青光眼内路小梁切开术与丝裂霉素C小梁切除术的比较：一项为期2年的随机临床试验

Ab-interno goniotrabeculotomy versus mitomycin C trabeculectomy for adult open-angle glaucoma: a 2-year randomized clinical trial.

作者信息

Quaranta L, Hitchings R A, Quaranta C A

机构信息

Institute of Ophthalmology, Moorfields Eye Hospital, London, England.

出版信息

Ophthalmology. 1999 Jul;106(7):1357-62. doi: 10.1016/S0161-6420(99)00725-3.

DOI:10.1016/S0161-6420(99)00725-3

PMID:10406622

Abstract

OBJECTIVE

To evaluate the effect of ab-interno goniotrabeculotomy (AIGT) on the intraocular pressure (IOP) in adult patients with primary open-angle glaucoma (POAG), compared with the effects of mitomycin C trabeculectomy (MT).

DESIGN

Prospective, randomized, clinical trial.

PARTICIPANTS

Thirty-two eyes of 32 patients with medically uncontrolled POAG.

INTERVENTION

Standard limbus-based trabeculectomy with adjunct mitomycin C (0.3 mg/mL for 3 minutes) in 16 eyes of 16 patients; AIGT was performed in 16 eyes of 16 patients. The groups were matched for age, preoperative IOP, duration of preoperative antiglaucoma treatment, use of preoperative beta-blockers and parasympathomimetics, and use of beta-blockers in the fellow eye. The IOP (average of the two highest values measured in the diurnal curve, from 8 AM to 6 PM, every 2 hours) and complications were recorded 1, 3, 6, 12, 18, and 24 months after surgery.

MAIN OUTCOME MEASURES

Identification of complications and IOP.

RESULTS

All patients were followed up for 24 months. More postoperative complications occurred in the MT group during the 2-year follow-up. One month after surgery, IOP was 10 +/- 1.46 mmHg (range, 8-13) in the MT group and 12.12 +/- 1.63 mmHg (range, 8-14) in the AIGT group (Student's t test, P = 0.001). Three months after surgery, IOP was 11.5 +/- 1.59 mmHg (range, 8-14) and 12.75 +/- 1.57 mmHg (range, 10-16) in the MT and AIGT groups, respectively (Student's t test, P = 0.033). From the 6th to the 24th postoperative month, no statistically significant difference in IOP was found between the two groups. At the end of follow-up, 14 of 16 eyes (87.5%) of the AIGT group and 13 of the 16 eyes (81.25%) of the MT group showed an IOP < or = 14 mmHg.

CONCLUSION

Ab-interno goniotrabeculotomy appears to be a viable and safe surgical treatment for adult POAG. More extended follow-up, however, and a larger series of patients are needed to ascertain the actual effectiveness of this procedure in adult POAG.

摘要

目的

与丝裂霉素C小梁切除术（MT）的效果相比较，评估内路房角小梁切开术（AIGT）对成年原发性开角型青光眼（POAG）患者眼压（IOP）的影响。

设计

前瞻性随机临床试验。

参与者

32例药物治疗无法控制的POAG患者的32只眼。

干预措施

16例患者的16只眼行标准的基于角膜缘的小梁切除术并辅助使用丝裂霉素C（0.3 mg/mL，持续3分钟）；16例患者的16只眼行AIGT。两组在年龄、术前眼压、术前抗青光眼治疗时间、术前β受体阻滞剂和拟副交感神经药的使用情况以及对侧眼β受体阻滞剂的使用情况方面进行匹配。记录术后1、3、6、12、18和24个月时的眼压（上午8点至下午6点每2小时测量的两个最高值的平均值）和并发症。

主要观察指标

并发症的识别和眼压。

结果

所有患者均随访24个月。在2年随访期间，MT组术后并发症更多。术后1个月，MT组眼压为10±1.46 mmHg（范围8 - 13），AIGT组眼压为12.12±1.63 mmHg（范围8 - 14）（Student t检验，P = 0.001）。术后3个月，MT组眼压为11.5±1.59 mmHg（范围8 - 14），AIGT组眼压为12.75±1.57 mmHg（范围10 - 16）（Student t检验，P = 0.033）。术后第6个月至第24个月，两组眼压无统计学显著差异。随访结束时，AIGT组16只眼中的14只（87.5%）和MT组16只眼中的13只（81.25%）眼压≤14 mmHg。