Flach Allan Joseph
Department of Ophthalmology, University of California, San Francisco, Medical Center, San Francisco, California, USA.
Trans Am Ophthalmol Soc. 2004;102:219-23; discussion 223-4.
Many ophthalmologists believe that long-term use of topically applied glaucoma medications can adversely affect results of fistulizing surgery. This presentation critically analyzes the published studies most often cited in support of this view to determine whether this conclusion is justified.
Morphologic effects of long-term treatment with antiglaucoma drugs on the conjunctiva and Tenon's capsule in glaucomatous patients have been studied. The results of these studies encouraged investigators to examine the influence of prior therapy on the success of trabeculectomy performed in patients with open-angle glaucoma. From this work, many have concluded that long-term use of topically applied glaucoma medications can adversely affect the results of fistulizing surgery. These results and conclusions are summarized and critically analyzed to determine whether this conclusion is justified.
Morphologic studies describe increased numbers of macrophages, fibroblasts, lymphocytes, and mast cells in conjunctival and Tenon's capsule specimens taken from patients receiving long-term antiglaucoma drugs. These findings suggest a potential for more inflammation and subsequent scarring following trabeculectomies in these patients. Efforts to confirm the clinical relevance of these histologic findings in open-angle glaucoma patients with a history of long-term antiglaucoma medication prior to surgery have been published. These retrospective, nonrandomized, unmasked studies of open-angle glaucoma patients include treatment groups and surgeries that are not comparable. In addition, the medical treatments within these studies do not reflect our current approaches to the medical management of open-angle glaucoma.
At present, there is no convincing clinical evidence that long-term medical treatments influence the success of contemporary trabeculectomy surgery performed on open-angle glaucoma patients.
许多眼科医生认为，长期局部使用青光眼药物会对造瘘手术的效果产生不利影响。本报告对最常被引用来支持这一观点的已发表研究进行批判性分析，以确定这一结论是否合理。
研究了青光眼患者长期使用抗青光眼药物对结膜和眼球筋膜囊的形态学影响。这些研究结果促使研究人员考察既往治疗对开角型青光眼患者小梁切除术成功率的影响。基于这项工作，许多人得出结论，长期局部使用青光眼药物会对造瘘手术的效果产生不利影响。对这些结果和结论进行总结并批判性分析，以确定这一结论是否合理。
形态学研究描述了从接受长期抗青光眼药物治疗的患者获取的结膜和眼球筋膜囊标本中巨噬细胞、成纤维细胞、淋巴细胞和肥大细胞数量增加。这些发现表明，这些患者小梁切除术后发生更多炎症及随后瘢痕形成的可能性增加。已发表了一些努力，旨在证实这些组织学发现在术前有长期抗青光眼药物治疗史的开角型青光眼患者中的临床相关性。这些对开角型青光眼患者的回顾性、非随机、非盲法研究包括不可比的治疗组和手术。此外，这些研究中的药物治疗并未反映我们目前对开角型青光眼的药物治疗方法。
目前，没有令人信服的临床证据表明长期药物治疗会影响对开角型青光眼患者实施的当代小梁切除术的成功率。
