Quigley H A, Buhrmann R R, West S K, Isseme I, Scudder M, Oliva M S
Dana Center for Preventive Ophthalmology, Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Br J Ophthalmol. 2000 Aug;84(8):860-4. doi: 10.1136/bjo.84.8.860.
To evaluate the long term results of glaucoma surgery among people in East Africa.
Participants in a population based survey of eye disease prevalence were offered glaucoma surgery using standardised criteria. Either surgical iridectomy or trabeculectomy was carried out as indicated by a medical officer or by one of two ophthalmologists. Trabeculectomy methods included releasable sutures and mitomycin C in the majority of eyes. Subjects were examined during the first week and 2 months after surgery. Nearly 3 years later, re-examination was carried out in those who were still resident in the region.
Among 46 people who were offered iridectomy, trabeculectomy, or combined cataract extraction/lens implant/trabeculectomy, 21 people underwent surgery (46%). Of the 21, 19 were re-examined at 3 years (90%), including 16/18 eyes after trabeculectomy. Among these, intraocular pressure (IOP) declined from 29.9 (SD 9.4) mm Hg to 14.7 (5.9) mm Hg, with 16 of 18 eyes (89%) achieving a reduction > 25%. Hypotony maculopathy, late bleb leak, and late endophthalmitis were not detected. Visually significant cataract developed in 5/15 re-examined eyes that underwent trabeculectomy alone (33%), possibly associated with pre-existing cataract and diagnosis of angle closure glaucoma, but not with mitomycin C use.
Nearly half of those with glaucoma among residents of rural African villages accepted the offer of surgical therapy. While technical success was achieved at satisfactory levels, the development of cataract must be considered an important issue for application of glaucoma surgical therapy programmes.
评估东非人群青光眼手术的长期效果。
在一项基于人群的眼病患病率调查中，为参与者提供符合标准化标准的青光眼手术。由医务人员或两名眼科医生之一根据情况进行手术虹膜切除术或小梁切除术。小梁切除术方法在大多数眼中包括可松解缝线和丝裂霉素C。在术后第一周和2个月对受试者进行检查。近3年后，对仍居住在该地区的受试者进行复查。
在46名接受虹膜切除术、小梁切除术或白内障摘除/晶状体植入/小梁切除术联合治疗的患者中，21人接受了手术（46%）。在这21人中，19人在3年后接受了复查（90%），其中小梁切除术后18只眼中的16只接受了复查。在这些眼中，眼压从29.9（标准差9.4）毫米汞柱降至14.7（5.9）毫米汞柱，18只眼中的16只（89%）眼压降低超过25%。未检测到低眼压性黄斑病变、晚期滤泡渗漏和晚期眼内炎。在仅接受小梁切除术的15只复查眼中，有5只（33%）出现了具有视觉意义的白内障，这可能与术前存在的白内障和闭角型青光眼的诊断有关，但与丝裂霉素C的使用无关。
非洲农村村庄居民中近一半青光眼患者接受了手术治疗。虽然技术成功率达到了令人满意的水平，但白内障的发生必须被视为青光眼手术治疗方案应用中的一个重要问题。
