Emerick Geoffrey T, Gedde Steven J, Budenz Donald L
Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida.
J Glaucoma. 2002 Aug;11(4):340-6. doi: 10.1097/00061198-200208000-00011.
To evaluate the efficacy and safety of tube fenestrations in eyes undergoing polyglactin suture-ligated Baerveldt Glaucoma Implant surgery.
The authors performed a retrospective nonrandomized comparative interventional study of consecutive cases of 111 eyes of 111 patients with refractory glaucoma who received polyglactin (Vicryl) suture-ligated Baerveldt 350 implants as a single procedure. In 69 of these cases (group 1), fenestrations were placed anterior to the ligature using a suture needle. In 42 cases (group 2), no fenestrations were performed. Main outcome measures included intraocular pressure, visual acuity, and complications.
Mean (+/- SD) preoperative intraocular pressure was 36.7 +/- 10.2 mm Hg in group 1 and 28.3 +/- 10.3 mm Hg in group 2 (P <0.001). Postoperative mean intraocular pressure was lower in group 1 than in group 2 at day 1 (20.2 +/- 12.8 vs. 29.3 +/- 1.9 mm Hg, P <0.001) and week 1 (18.3 +/- 10.4 vs. 23.7 +/- 8.6 mm Hg, P = 0.006), but was virtually identical at 1 year (12.7 +/- 4.9 vs. 12.6 +/- 4.4 mm Hg, P = 0.95). Number of glaucoma medications used by group 1 patients was significantly lower up to 3 months (P </=0.05). Complication rates were similar in both groups. After tube opening at a mean of 36 +/- 4.7 days, there was an equal and sustained intraocular pressure reduction in both groups in patients taking a similar number of glaucoma medicines up to 12 months after surgery.
Tube fenestrations provide safe and effective short-term intraocular pressure control with fewer glaucoma medications in a ligated nonvalved glaucoma drainage implant, with comparable intraocular pressure control and medications required at 1 year. However, not all patients have sustained reduction of intraocular pressure in the immediate postoperative period with fenestrations, making the effect somewhat unpredictable.
评估在接受聚乙醇酸缝线结扎的Baerveldt青光眼植入物手术的眼中进行引流管开窗术的疗效和安全性。
作者对111例难治性青光眼患者的111只眼睛进行了一项回顾性非随机对照干预研究，这些患者均接受了聚乙醇酸（薇乔）缝线结扎的Baerveldt 350植入物单手术。其中69例（第1组），使用缝合针在结扎线前方进行开窗。42例（第2组）未进行开窗。主要观察指标包括眼压、视力和并发症。
第1组术前平均（±标准差）眼压为36.7±10.2 mmHg，第2组为28.3±10.3 mmHg（P<0.001）。术后第1天（20.2±12.8对29.3±1.9 mmHg，P<0.001）和第1周（18.3±10.4对23.7±8.6 mmHg，P = 0.006）第1组的术后平均眼压低于第2组，但在1年时基本相同（12.7±4.9对12.6±4.4 mmHg，P = 0.95）。第1组患者使用的青光眼药物数量在3个月内显著减少（P≤0.05）。两组并发症发生率相似。在平均36±4.7天引流管开放后，在术后12个月内服用相似数量青光眼药物的患者中，两组眼压均有同等程度且持续的降低。
在结扎无瓣膜青光眼引流植入物中，引流管开窗术能安全有效地短期控制眼压，减少青光眼药物使用，1年时眼压控制和所需药物相当。然而，并非所有患者在术后即刻眼压都能因开窗而持续降低，其效果有点不可预测。
