Molteno A C, Bosma N J, Kittelson J M
Department of Ophthalmology, University of Otago Medical School, Dunedin, New Zealand.
Ophthalmology. 1999 Sep;106(9):1742-50. doi: 10.1016/S0161-6420(99)90351-2.
To provide data on the long-term results of trabeculectomy performed in the province of Otago, New Zealand.
Retrospective noncomparative case series.
A total of 289 eyes of 193 patients (excluding 4 eyes lost to follow-up soon after operation); all trabeculectomies performed for the first time on cases of primary glaucoma from 1976 through 1995.
Standard Cairns trabeculectomy.
Intraocular pressure, visual acuity, visual field damage.
Trabeculectomy was effective in controlling intraocular pressure at a level of 21 mmHg or less, with probabilities of 0.93 (95% confidence interval [CI], 0.90-0.97), 0.87 (95% CI, 0.82-0.93), and 0.85 (95% CI, 0.77-0.92) at 5, 10, and 15 years, respectively, after surgery. The mean visual acuity improved from 20/60 to 20/40 immediately after trabeculectomy but then declined steadily over the postoperative years. The decline in visual acuity led to blindness in 47 eyes. The Kaplan-Meier estimated probability of retaining useful vision (visual acuity > 20/400 and visual field > 5 degrees radius) in the overall group was 0.87 (95% CI, 0.79-0.91), 0.72 (95% CI, 0.60-0.79), and 0.6 (95% CI, 0.43-0.69) at 5, 10, and 15 years, respectively, after surgery. Those eyes that had good preoperative visual acuity (visual acuity > or = 20/30) had a significantly better chance of retaining useful vision (P = 0.02).
The intraocular pressure was well controlled by trabeculectomy, but a steady long-term decline in visual acuity and visual field occurred, decreasing the probability of an eye retaining useful vision up to the time of death to approximately 0.6.
提供新西兰奥塔哥省小梁切除术的长期结果数据。
回顾性非对照病例系列。
193例患者共289只眼（不包括术后不久失访的4只眼）；所有小梁切除术均为1976年至1995年首次对原发性青光眼病例施行。
标准凯恩斯小梁切除术。
眼压、视力、视野损害。
小梁切除术能有效将眼压控制在21 mmHg或更低水平，术后5年、10年和15年时达到该水平的概率分别为0.93（95%置信区间[CI]，0.90 - 0.97）、0.87（95% CI，0.82 - 0.93）和0.85（95% CI，0.77 - 0.92）。小梁切除术后视力立即从20/60提高到20/40，但随后在术后数年稳步下降。视力下降导致47只眼失明。总体组中，术后5年、10年和15年时保留有用视力（视力>20/400且视野>5度半径）的Kaplan-Meier估计概率分别为0.87（95% CI，0.79 - 0.91）、0.72（95% CI，0.60 - 0.79）和0.6（95% CI，0.43 - 0.69）。术前视力良好（视力≥20/30）的眼保留有用视力的机会显著更高（P = 0.02）。
小梁切除术能很好地控制眼压，但视力和视野出现长期稳步下降，使眼睛直至死亡时保留有用视力的概率降至约0.6。
