[青光眼滤过性手术后白内障超声乳化吸出术的结果]

Gracner T, Falez M, Gracner B, Pahor D

Augenabteilung, Universitätskrankenhaus Maribor, Maribor, Slowenien.

Klin Monbl Augenheilkd. 2005 Apr;222(4):332-6. doi: 10.1055/s-2005-858034.

BACKGROUND

Our aim was to evaluate the outcome of phacoemulsification in eyes after filtering glaucoma surgery.

PATIENTS AND METHODS

Thirty eyes of 30 patients with different forms of glaucoma in which phacoemulsification after filtering glaucoma surgery was done were included in this retrospective study. Intraocular pressure (IOP) was measured before and one week, 1, 3, 6, 12, 18, 24, 30, 36 and 42 months after phacoemulsification. The best corrected visual acuity (BCVA) and the number of antiglaucoma medications before phacoemulsification and at the end of follow-up were evaluated. Partial failure of IOP control was defined as the need for an increased number of antiglaucoma medications to maintain IOP < 21 mmHg or prevent a progression of visual field or optic disc damage. Complete failure of IOP control was defined as an IOP > 21 mmHg with an additional number of antiglaucoma medications or a progression of visual field or optic disc damage requiring filtering surgery.

RESULTS

The mean interval between filtration surgery and phacoemulsification was 5.8 years (SD 3.8) and the mean follow-up after phacoemulsification was 23.4 months (SD 11.4). There were no differences between the mean IOP before and after phacoemulsification during the entire follow-up period (p > 0.05). The mean preoperative BCVA was 0.30 (SD 0.2), improving to a mean of 0.72 (SD 0.3) postoperatively at the end of follow-up (p < 0.0001). The mean number of antiglaucoma medications before phacoemulsification was 1.2 (SD 1.2), increasing after phacoemulsification to 1.5 (SD 1.2) at the end of follow-up (p > 0.05). In 9 eyes a partial failure of IOP control was assessed, so according to the Kaplan-Meier survival analysis the success rate after 12 months was 72 % and after 42 months 67 %. In 3 eyes a complete failure of IOP control was assessed, thus according to the Kaplan-Meier survival analysis the success rate after 22 months was 93 % and after 42 months 77 %.

CONCLUSION

Phacoemulsification in eyes after filtering glaucoma surgery resulted in a stable IOP, a non-significant increase in the number of antiglaucoma medications and a significantly improved BCVA.

背景

我们的目的是评估青光眼滤过手术后行白内障超声乳化术的效果。

患者与方法

本回顾性研究纳入了30例患有不同类型青光眼且在青光眼滤过手术后行白内障超声乳化术的患者的30只眼。在白内障超声乳化术前以及术后1周、1、3、6、12、18、24、30、36和42个月测量眼压（IOP）。评估白内障超声乳化术前及随访结束时的最佳矫正视力（BCVA）和抗青光眼药物的使用数量。眼压控制部分失败定义为需要增加抗青光眼药物数量以维持眼压<21 mmHg或防止视野或视盘损害进展。眼压控制完全失败定义为眼压>21 mmHg且使用额外的抗青光眼药物，或视野或视盘损害进展需要行滤过手术。

结果

滤过手术与白内障超声乳化术之间的平均间隔时间为5.8年（标准差3.8），白内障超声乳化术后的平均随访时间为23.4个月（标准差11.4）。在整个随访期间，白内障超声乳化术前和术后的平均眼压无差异（p>0.05）。术前平均BCVA为0.30（标准差0.2），随访结束时术后平均提高至0.72（标准差0.3）（p<0.0001）。白内障超声乳化术前抗青光眼药物的平均使用数量为1.2（标准差1.2），随访结束时白内障超声乳化术后增加至1.5（标准差1.2）（p>0.05）。9只眼中评估为眼压控制部分失败，因此根据Kaplan-Meier生存分析，12个月后的成功率为72%，42个月后为67%。3只眼中评估为眼压控制完全失败，因此根据Kaplan-Meier生存分析，22个月后的成功率为93%，42个月后为77%。