Scott I U, Alexandrakis G, Flynn H W, Smiddy W E, Murray T G, Schiffman J, Gedde S J, Budenz D L, Fantes F, Parrish R K
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL 33136, USA.
Am J Ophthalmol. 2000 Mar;129(3):334-41. doi: 10.1016/s0002-9394(99)00363-3.
To report visual acuity and intraocular pressure outcomes among patients who have undergone combined pars plana vitrectomy and placement of a glaucoma drainage implant.
The medical records of all patients who underwent combined pars plana vitrectomy and placement of a glaucoma drainage implant at the Bascom Palmer Eye Institute by one of the authors between January 1, 1990, and February 28, 1998, were reviewed. Forty patients (40 eyes) were identified, including 14 patients with neovascular glaucoma secondary to proliferative diabetic retinopathy or central retinal vein occlusion, 15 patients with other posterior segment disease, seven patients with secondary angle-closure glaucoma, and four patients with aphakia with ruptured anterior hyaloid face. Main outcome measures included visual acuity and intraocular pressure at 1 year postoperatively.
At 1 year postoperatively, 31 (77.5%) of 40 patients had stable or improved visual acuity; three eyes (7. 5%) had a final visual acuity of no light perception and three additional eyes (7.5%) were enucleated (because of chronic pain in two eyes and endophthalmitis in one eye). Mean preoperative intraocular pressure was 34 mm Hg and the median number of preoperative antiglaucoma medications was two. At 1 year postoperatively, mean intraocular pressure was 13 mm Hg and the median number of antiglaucoma medications was zero. Twenty-two patients (55.0%) achieved an intraocular pressure greater than 5 mm Hg and less than or equal to 21 mm Hg without antiglaucoma medication, and an additional seven patients (17.5%) achieved this level of intraocular pressure control with medication. Only one patient (2.5%) underwent further glaucoma surgery for uncontrolled intraocular pressure.
Although combined pars plana vitrectomy and placement of a glaucoma drainage implant is often a successful management option in selected patients with refractory glaucoma, visual outcome may be poor because of severe underlying ocular disease and postoperative complications.
报告接受玻璃体切割联合青光眼引流植入物植入术患者的视力和眼压结果。
回顾了1990年1月1日至1998年2月28日期间由本文作者之一在巴斯科姆·帕尔默眼科研究所接受玻璃体切割联合青光眼引流植入物植入术的所有患者的病历。确定了40例患者（40只眼），其中包括14例继发于增殖性糖尿病视网膜病变或视网膜中央静脉阻塞的新生血管性青光眼患者、15例其他后段疾病患者、7例继发性闭角型青光眼患者以及4例伴有前玻璃体膜破裂的无晶状体眼患者。主要观察指标包括术后1年时的视力和眼压。
术后1年时，40例患者中有31例（77.5%）视力稳定或提高；3只眼（7.5%）最终视力为无光感，另有3只眼（7.5%）被摘除眼球（2只眼因慢性疼痛，1只眼因眼内炎）。术前平均眼压为34 mmHg，术前抗青光眼药物的中位数为2种。术后1年时，平均眼压为13 mmHg，抗青光眼药物的中位数为0种。22例患者（55.0%）在未使用抗青光眼药物的情况下眼压大于5 mmHg且小于或等于21 mmHg，另有7例患者（17.5%）通过药物治疗达到了该眼压控制水平。只有1例患者（2.5%）因眼压控制不佳接受了进一步的青光眼手术。
尽管玻璃体切割联合青光眼引流植入物植入术在部分难治性青光眼患者中通常是一种成功的治疗选择，但由于严重的潜在眼部疾病和术后并发症，视力预后可能较差。
