联合Baerveldt青光眼引流植入物与丝裂霉素C小梁切除术治疗难治性青光眼。
Combined Baerveldt glaucoma drainage implant and trabeculectomy with mitomycin C for refractory glaucoma.
作者信息
Budenz Donald L, Scott Ingrid U, Nguyen Quang H, Feuer William, Singh Kuldev, Nicolela Marcelo T, Bueche Michael, Palmberg Paul F
机构信息
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida 33136, USA.
出版信息
J Glaucoma. 2002 Oct;11(5):439-45. doi: 10.1097/00061198-200210000-00013.
PURPOSE
To describe the surgical technique and clinical outcomes of a procedure for refractory glaucoma, concurrent Baerveldt glaucoma implant (BGI) and trabeculectomy with mitomycin C.
MATERIALS AND METHODS
Medical records of all patients who underwent combined Prolene-ligated BGI and trabeculectomy with mitomycin C were retrospectively reviewed. Main outcome measures were intraocular pressure (IOP), number of glaucoma medications, visual acuity, and complications. Kaplan-Meier survival analysis was used to determine success, defined as IOP < 22 mm Hg, no reoperation for glaucoma, and no loss of light perception vision.
RESULTS
The mean +/- SD follow-up period for 38 eyes of 36 patients was 34 +/- 36 months (range, 3-121 months), during which 18 of 38 eyes (47%) required laser suture lysis of the Prolene suture. Intraocular pressure was reduced from a mean (+/- SD) preoperative value of 35.7 +/- 12.8 to 12.7 +/- 4.7 mm Hg at 1-year follow-up and 11.9 +/- 5.5 mm Hg at the last follow-up visit ( < 0.001). Number of medicines used for glaucoma was reduced from a mean +/- SD preoperative value of 2.5 +/- 0.9 to 0.5 +/- 0.6 at 1-year follow-up and 0.6 +/- 0.8 at the last follow-up visit ( < 0.001). LogMar visual acuity remained stable at mean of 1.15 +/- 0.85 preoperatively, compared with 1.14 +/- 1.05 at 1-year follow-up, but declined to 1.61 +/- 1.01 at the last follow-up visit, a loss of an average of four lines of vision ( = 0.004). Cumulative success was 91% at year 1, 86% at year 2, and 81% at year 3. Three eyes (8%) had suprachoroidal hemorrhages, one eye (3%) needed reoperation for an extruded implant, one (3%) eye had poor vision due to chronic hypotony, three eyes (8%) required additional glaucoma surgery during the postoperative period, and one eye (3%) needed revision of the implant for pressure control.
CONCLUSIONS
Combined BGI and mitomycin C trabeculectomy provides excellent postoperative IOP control in patients with refractory glaucoma.
目的
描述难治性青光眼联合贝尔维尔德特青光眼植入物（BGI）和丝裂霉素C小梁切除术的手术技术及临床结果。
材料与方法
回顾性分析所有接受普理灵结扎BGI联合丝裂霉素C小梁切除术患者的病历。主要观察指标为眼压（IOP）、青光眼药物使用数量、视力及并发症。采用Kaplan-Meier生存分析确定手术成功与否，成功定义为眼压<22 mmHg、无需因青光眼再次手术且无光感丧失。
结果
36例患者的38只眼平均随访时间为34±36个月（范围3 - 121个月），38只眼中有18只眼（47%）需要对普理灵缝线进行激光缝线松解。眼压从术前平均（±标准差）35.7±12.8 mmHg降至1年随访时的12.7±4.7 mmHg，末次随访时为11.9±5.5 mmHg（P<0.001）。青光眼用药数量从术前平均±标准差2.5±0.9降至1年随访时的0.5±0.6，末次随访时为0.6±0.8（P<0.001）。术前平均LogMar视力为1.15±0.85，1年随访时为1.14±1.05，末次随访时降至1.61±1.01，平均视力下降4行（P = 0.004）。1年时累积成功率为91%，2年时为86%，3年时为81%。3只眼（8%）发生脉络膜上腔出血，1只眼（3%）因植入物脱出需要再次手术，1只眼（3%）因慢性低眼压视力差，3只眼（8%）术后需要额外的青光眼手术，1只眼（3%）需要调整植入物以控制眼压。
结论
BGI联合丝裂霉素C小梁切除术为难治性青光眼患者提供了良好的术后眼压控制效果。
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