Stefan C, Nenciu A, Balas Mihaela, Neacşu Alina, Dachin Luminiţa, Ardelean Carmen
Institutul Naţional de Cercetare şi Dezvoltare în Domeniul Patologiei şi Stiinţelor Biomedicale, V. Babeş, Bucureşti.
Oftalmologia. 2003;59(4):19-23.
The topical treatment for a long run in glaucoma rises histopathological changes of conjunctiva. The study is aimed at assessing the correlations between conjunctival changes bound of the type and duration of medical glaucoma therapy and the efficiency of subsequent filtering surgery.
For this purpose, we carried out a three years clinical prospective study (01.05.2000-30.04.2003), with a mean follow-up period of 18.5 months, enrolling 22 cases (38 eyes) operated by trabeculectomy for primary open angle glaucoma (POAG), with the same technique and the same surgeon. There were excluded both the patients with previous ophthalmic surgical interventions and ocular/systemic chronic inflammatory disease. The cases were divided according to type and duration of topical treatment. There were recorded the conjunctival changes (by histological exam and immunohistochemistry), dynamic evolution of intraocular pressure (IOP) and the morphological aspects of filtering blebs. Statistical analysis was performed by Wilcoxon test.
In all groups, the efficiency of filtering surgery was correlated with the duration of topical medication; the survey presents the correlations between topical treatment, conjunctival changes and postoperative evolution.
These results suggest that exhaustive topical treatment in POAG, for a long period, with many drugs may represent a negative prognostic factor for the subsequent filtering surgery. Therefore it is necessary an individual approach for the first line therapy in POAG.
长期局部治疗青光眼会引发结膜的组织病理学变化。本研究旨在评估青光眼药物治疗的类型、持续时间所导致的结膜变化与后续滤过性手术效果之间的相关性。
为此，我们进行了一项为期三年的临床前瞻性研究（2000年5月1日至2003年4月30日），平均随访期为18.5个月，纳入22例（38只眼）因原发性开角型青光眼（POAG）接受小梁切除术的患者，手术由同一位外科医生采用相同技术进行。排除既往有眼科手术干预史以及患有眼部/全身慢性炎症性疾病的患者。根据局部治疗的类型和持续时间对病例进行分组。记录结膜变化（通过组织学检查和免疫组织化学）、眼压（IOP）的动态变化以及滤过泡的形态学特征。采用Wilcoxon检验进行统计分析。
在所有组中，滤过性手术的效果与局部用药的持续时间相关；该调查呈现了局部治疗、结膜变化与术后转归之间的相关性。
这些结果表明，长期使用多种药物对POAG进行彻底的局部治疗可能是后续滤过性手术的一个不良预后因素。因此，对于POAG的一线治疗需要采取个体化方法。
