Sung V C, Butler T K, Vernon S A
Department of Ophthalmology, Queen's Medical Centre, University Hospital, Nottingham, UK.
Eye (Lond). 2001 Feb;15(Pt 1):45-51. doi: 10.1038/eye.2001.12.
To determine the 1 year success rate of non-enhanced trabeculectomy under the care of non-glaucoma specialists and the effects of risk factors on the surgical outcome as measured by intraocular pressure (IOP) control.
A retrospective study of 167 patients undergoing trabeculectomy was performed. One hundred and four cases were performed in a teaching hospital and 63 in a district general hospital (DGH). Non-glaucoma specialists performed all the operations, enhanced trabeculectomy with antimetabolites being excluded. Information was recorded from a retrospective review of case notes, and post-operative IOPs at 12 months follow-up were analysed. Risk factors for failure were defined as: (1) age less than 40 years old, (2) black race, (3) diabetes mellitus, (4) miotic therapy > or = 18 months, (5) sympathomimetic therapy > or = 6 months, (6) pseudophakia or aphakia, (7) previous failed filtration procedure, (8) argon laser trabeculoplasty, (9) previous ocular surgery and (10) high-risk glaucoma (angle recession glaucoma, uveitic glaucoma and neovascular glaucoma). A success was defined to be a post-operative IOP at 1 year of less than 21 mmHg and at least 20% less than the presenting IOP on no medication.
The overall success rate was 139 of 167 (83.2%). Eighty-seven of 104 eyes (83.7%) were classified as a success in the teaching hospital group and 52 of 63 (82.5%) were classified as a success in the DGH group. There was no significant difference in the number of risk factors between the success and failure groups. Eyes with two or more risk factors had significantly higher IOPs at 1 year when compared with eyes with 0 or 1 risk factor (mean +/- SD: 17.4 +/- 6.34 mmHg vs 14.2 +/- 5.0 mmHg, p = 0.022). When only 'successful eyes' were analysed, those with two or more risk factors still had significantly higher IOPs at 1 year (mean +/- SD: 15.0 +/- 3.0 mmHg vs 12.8 +/- 3.9 mmHg, p = 0.046). There were significantly fewer eyes in the two or more risk factor group with IOPs < 16 mmHg at 1 year (26.1% vs 60.4%, p = 0.021).
Eyes at relatively low risk for failure operated upon by non-glaucoma specialists appeared to have success rates similar to previously published series. Eyes with two or more risk factors for failure have higher IOPs at 1 year in non-enchanced trabeculectomy. Adjunctive anti-scarring agents may be considered for these patients when filtration surgery is scheduled.
确定在非青光眼专科医生护理下非强化小梁切除术的1年成功率，以及危险因素对通过眼压（IOP）控制衡量的手术结果的影响。
对167例行小梁切除术的患者进行回顾性研究。104例在教学医院进行，63例在地区综合医院（DGH）进行。所有手术均由非青光眼专科医生完成，排除使用抗代谢药物的强化小梁切除术。通过回顾病例记录收集信息，并分析随访12个月时的术后眼压。失败的危险因素定义为：（1）年龄小于40岁，（2）黑人种族，（3）糖尿病，（4）缩瞳治疗≥18个月，（5）拟交感神经药治疗≥6个月，（6）人工晶状体眼或无晶状体眼，（7）既往滤过手术失败，（8）氩激光小梁成形术，（9）既往眼部手术，（10）高危青光眼（房角后退性青光眼、葡萄膜炎性青光眼和新生血管性青光眼）。成功定义为术后1年眼压低于21 mmHg且在未用药情况下比术前眼压至少降低20%。
167例中总体成功率为139例（83.2%）。教学医院组104眼中87眼（83.7%）被分类为成功，DGH组63眼中52眼（82.5%）被分类为成功。成功组和失败组之间危险因素数量无显著差异。与具有0或1个危险因素的眼相比，具有两个或更多危险因素的眼在1年时眼压显著更高（平均值±标准差：17.4±6.34 mmHg对14.2±5.0 mmHg，p = 0.022）。仅分析“成功眼”时，具有两个或更多危险因素的眼在1年时眼压仍显著更高（平均值±标准差：15.0±3.0 mmHg对12.8±3.9 mmHg，p = 0.046）。在两个或更多危险因素组中，1年时眼压<16 mmHg的眼明显更少（26.1%对60.4%，p = 0.021）。
由非青光眼专科医生手术的失败风险相对较低的眼，其成功率似乎与先前发表的系列相似。在非强化小梁切除术中，具有两个或更多失败危险因素的眼在1年时眼压更高。当计划进行滤过手术时，可考虑为这些患者使用辅助抗瘢痕形成药物。
