胶原植入物深层巩膜切除术的长期效果

Long-term results of deep sclerectomy with collagen implant.

作者信息

Shaarawy Tarek, Mansouri Kaweh, Schnyder Corinne, Ravinet Emile, Achache Farid, Mermoud André

机构信息

Hôpital Ophtalmique Jules Gonin, Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland.

出版信息

J Cataract Refract Surg. 2004 Jun;30(6):1225-31. doi: 10.1016/j.jcrs.2003.10.035.

DOI:10.1016/j.jcrs.2003.10.035

PMID:15177596

Abstract

PURPOSE

To study prospectively the success rate and complications of deep sclerectomy with collagen implant (DSCI).

SETTING

Glaucoma Unit, Department of Ophthalmology, Hôpital Ophtalmique Jules Gonin, University of Lausanne, Lausanne, Switzerland.

METHODS

This nonrandomized prospective trial comprised 105 eyes of 105 patients with medically uncontrolled primary and secondary open-angle glaucoma. Visual acuity, intraocular pressure (IOP), and slitlamp examinations were performed before surgery and after surgery at 1 and 7 days, and 1, 3, 6, 9, 12, 18, 24, 30, 36, 48, 54, 60, 66, 72, 78, 84, 90, and 96 months. Visual field examinations were repeated every 6 months.

RESULTS

Mean follow-up period was 64 months +/- 26.6 (SD). Mean preoperative IOP was 26.8 +/- 7.7 mm Hg, and mean postoperative IOP was 5.2 +/- 3.35 mm Hg at day 1 and 12 +/- 3 mm Hg at month 78. At 96 months, the qualified success rate (ie, patients who achieved IOP <21 mm Hg with and without medication) was 91%, and the complete success rate (ie, IOP <21 mm Hg without medication) was 57%. At 96 months, 34% of patients had an IOP <21 mm Hg with medication. Fifty-one patients (49%) achieved an IOP < or =15 mm Hg without medication. Neodymium:YAG goniopuncture was performed in 54 patients (51%); mean time of goniopuncture performance was 21 months, and mean IOP before goniopuncture was 20 mm Hg, dropping to 11 mm Hg after goniopuncture. No shallow or flat anterior chamber, endophthalmitis, or surgery-induced cataract was observed. However, 26 patients (25%) showed a progression of preexisting senile cataract (mean time 26 months; range 18 to 37 months). Injections of 5-fluorouracil were administered to 25 patients (23%) who underwent DSCI to salvage encysted blebs. Mean number of medications per patient was reduced from 2.3 +/- 0.7 to 0.5 +/- 0.7 (signed rank P<.0001).

CONCLUSION

Deep sclerectomy with collagen implant appears to provide stable and reasonable control of IOP at long-term follow-up with few immediate postoperative complications.

摘要

目的

前瞻性研究胶原植入物深层巩膜切除术（DSCI）的成功率和并发症。

设置

瑞士洛桑大学朱尔斯·戈宁眼科医院眼科青光眼科。

方法

这项非随机前瞻性试验纳入了105例药物治疗无法控制的原发性和继发性开角型青光眼患者的105只眼睛。在手术前以及术后1天、7天、1个月、3个月、6个月、9个月、12个月、18个月、24个月、30个月、36个月、48个月、54个月、60个月、66个月、72个月、78个月、84个月、90个月和96个月进行视力、眼压（IOP）和裂隙灯检查。每6个月重复进行一次视野检查。

结果

平均随访期为64个月±26.6（标准差）。术前平均眼压为26.8±7.7 mmHg，术后第1天平均眼压为5.2±3.35 mmHg，第78个月时为12±3 mmHg。在96个月时，合格成功率（即使用或不使用药物眼压<21 mmHg的患者）为91%，完全成功率（即不使用药物眼压<21 mmHg）为57%。在96个月时，34%的患者使用药物后眼压<21 mmHg。51例患者（49%）不使用药物眼压≤15 mmHg。54例患者（51%）进行了钕：钇铝石榴石激光周边虹膜切开术；平均激光周边虹膜切开术时间为21个月，激光周边虹膜切开术前平均眼压为20 mmHg，术后降至11 mmHg。未观察到浅前房或无前房、眼内炎或手术引起的白内障。然而，26例患者（25%）出现了原有老年性白内障进展（平均时间26个月；范围18至37个月）。25例接受DSCI的患者（23%）注射了5-氟尿嘧啶以挽救包裹性滤过泡。每位患者的平均用药数量从2.3±0.7减少至0.5±0.7（符号秩检验P<0.0001）。