Wilson M R, Mendis U, Smith S D, Paliwal A
Creighton University School of Medicine, Omaha, Nebraska 68178, USA.
Am J Ophthalmol. 2000 Sep;130(3):267-73. doi: 10.1016/s0002-9394(00)00473-6.
To compare the short- and intermediate-term results of two commonly used glaucoma surgical procedures, trabeculectomy and Ahmed glaucoma valve implant.
A randomized clinical trial was performed at two international centers. One eye each of consecutive patients requiring glaucoma surgery for intraocular pressure control was randomized to receive either trabeculectomy or the Ahmed implant.
Of the 117 patients, 62 were randomized to trabeculectomy and 55 to the Ahmed implant. With a mean follow-up of 9.7 months, the trabeculectomy group had statistically lower intraocular pressures at weeks 6 to 15 (12.6 mm Hg vs 16.4 mm Hg) and months 11 to 13 (11.4 mm Hg vs 17.2 mm Hg) than the Ahmed implant group. Compared with preoperative status, no statistically significant differences between groups were noted for visual acuity, visual field, lens status, and final anterior chamber depth. The cumulative probabilities of success (intraocular pressure <21 mm Hg and at least 15% reduction in intraocular pressure from preoperative level) were 83.6% for trabeculectomy and 88.1% for Ahmed implant (P =.43). However, the Ahmed implant group had a greater adjunctive medication requirement. On the last visit, 10 of the trabeculectomy eyes and 19 of the Ahmed implant eyes required at least one topical medication (P =.01). There was no statistically significant difference in the rate of complications between the two groups.
Lower mean intraocular pressures were noted for the trabeculectomy group. All other results, including success (as defined in this study) and frequency of complications, were comparable between the two groups.
比较两种常用青光眼手术方法小梁切除术和艾哈迈德青光眼引流阀植入术的短期和中期效果。
在两个国际中心进行了一项随机临床试验。连续需要进行青光眼手术以控制眼压的患者，每只眼睛随机接受小梁切除术或艾哈迈德引流阀植入术。
117例患者中，62例被随机分配接受小梁切除术，55例接受艾哈迈德引流阀植入术。平均随访9.7个月，小梁切除术组在第6至15周（12.6毫米汞柱对16.4毫米汞柱）和第11至13个月（11.4毫米汞柱对17.2毫米汞柱）的眼压在统计学上低于艾哈迈德引流阀植入术组。与术前状态相比，两组在视力、视野、晶状体状态和最终前房深度方面无统计学显著差异。小梁切除术的成功累积概率（眼压<21毫米汞柱且眼压较术前水平降低至少15%）为83.6%，艾哈迈德引流阀植入术为88.1%（P = 0.43）。然而，艾哈迈德引流阀植入术组需要更多辅助药物。在最后一次随访时，小梁切除术组的10只眼睛和艾哈迈德引流阀植入术组的19只眼睛至少需要一种局部用药（P = 0.01）。两组并发症发生率无统计学显著差异。
小梁切除术组的平均眼压较低。两组的所有其他结果，包括成功（本研究定义）和并发症发生率，均具有可比性。
