Rebolleda Gema, Muñoz-Negrete Francisco J
Hospital Ramón y Cajal, Ophthalmology Department, Glaucoma Unit, Madrid, Spain.
Ophthalmology. 2002 Dec;109(12):2248-55. doi: 10.1016/s0161-6420(02)01246-0.
To evaluate the effect of phacoemulsification on intraocular pressure (IOP) control in eyes with a previous functioning filtering bleb and no glaucoma medication.
Prospective, nonrandomized comparative (self-controlled) trial.
Forty-seven patients (49 eyes) who underwent phacoemulsification after successful trabeculectomy, with at least 12 months of follow-up.
Clear corneal phacoemulsification and implantation of a foldable intraocular lens in eyes that underwent a previous successful trabeculectomy. The time between both procedures was always greater than 1 year.
Preoperative and postoperative IOP, the number of glaucoma medications, bleb appearance, and visual acuity were recorded at each follow-up examination. Success was defined as no need for glaucoma medications, bleb needling, or further glaucoma surgery for IOP control after phacoemulsification. Preoperative and intraoperative factors were evaluated for an association with postoperative failure using Kaplan-Meier survival analysis.
The mean (+/- standard deviation) IOP before phacoemulsification was 12.24 (+/- 4.68) mmHg, and it increased 3.94, 3.76, 1.39, 2.04, and 1.57 mmHg on the first postoperative day, after 1, 6, and 12 months, and at the last visit, respectively. At each interval, the mean IOP was significantly higher than the preoperative value (P = 0.000, 0.000, 0.049, 0.01, and 0.01, respectively). Nevertheless, the mean IOP after phacoemulsification was always lower than before trabeculectomy (P = 0.000). At the last visit, glaucoma medication was required in 17 eyes (34.7%). The success rates after phacoemulsification were 83.6%, 68.2%, and 55.7% at 6 months and 1 and 2 years, respectively (Kaplan-Meier survival analysis). The number of glaucoma medications used increased at all follow-up visits (P < 0.005). Bleb size decreased after phacoemulsification (P = 0.000). An IOP before phacoemulsification of greater than 10 mmHg was associated with postoperative failure (P = 0.002). Similarly, bleb failure and the need for glaucoma medication were associated with higher IOPs before phacoemulsification.
Phacoemulsification significantly increased IOP and the number of glaucoma medications in eyes with preexisting functioning filtering blebs. Eyes with higher IOPs before phacoemulsification had worsened postoperative IOP control and bleb failure.
评估超声乳化白内障吸除术对既往有功能性滤过泡且未使用青光眼药物治疗的患者眼压（IOP）控制的效果。
前瞻性、非随机对照（自身对照）试验。
47例患者（49只眼），这些患者在小梁切除术后成功接受了超声乳化白内障吸除术，并至少随访12个月。
对既往小梁切除术成功的患者行透明角膜超声乳化白内障吸除术并植入可折叠人工晶状体。两次手术间隔时间均大于1年。
每次随访时记录术前和术后眼压、青光眼药物使用数量、滤过泡外观及视力。成功定义为超声乳化白内障吸除术后无需使用青光眼药物、进行滤过泡针刺或进一步的青光眼手术来控制眼压。采用Kaplan-Meier生存分析评估术前和术中因素与术后失败的相关性。
超声乳化白内障吸除术前平均（±标准差）眼压为12.24（±4.68）mmHg，术后第1天、1个月、6个月、12个月及最后一次随访时眼压分别升高3.94、3.76、1.39、2.04及1.57 mmHg。在每个时间点，平均眼压均显著高于术前值（P分别为0.000、0.000、0.049、0.01及0.01）。然而，超声乳化白内障吸除术后的平均眼压始终低于小梁切除术前（P = 0.000）。在最后一次随访时，17只眼（34.7%）需要使用青光眼药物。超声乳化白内障吸除术后6个月、1年及2年的成功率分别为83.6%、68.2%及55.7%（Kaplan-Meier生存分析）。在所有随访中，青光眼药物使用数量均增加（P < 0.005）。超声乳化白内障吸除术后滤过泡大小减小（P = 0.000）。超声乳化白内障吸除术前眼压大于10 mmHg与术后失败相关（P = 0.002）。同样，滤过泡失败及需要使用青光眼药物与超声乳化白内障吸除术前较高的眼压相关。
超声乳化白内障吸除术可显著提高既往有功能性滤过泡患者的眼压及青光眼药物使用数量。超声乳化白内障吸除术前眼压较高的患者术后眼压控制及滤过泡失败情况更差。
