军事卫生服务研究所临床资料中深层巩膜切除术联合白内障超声乳化吸除术及单纯深层巩膜切除术的疗效与安全性——年度观察

Efficacy and safety of deep sclerectomy and phacoemulsification and deep sclerectomy in clinical material of Military Health Service Institute--yearly observations.

作者信息

Marek Rekas, Joanna Wierzhowska, Lewczuk Katarzyna, Siemiatkowska Anna, Stankiewicz Andrzej

机构信息

Departament of Ophthalmology, Military Health Service Institute, Warsaw.

出版信息

Klin Oczna. 2006;108(10-12):385-91.

DOI:

PMID:17455710

Abstract

PURPOSE

Comparison of the effectiveness of nonpenetrated deep sclerectomy (DS) as the only procedure in relation to operation combined with phacoemulsification (FDS) in treatment of patients with open-angle glaucoma based on yearly observation.

MATERIAL AND METHODS

67 eyes with open-angle glaucoma were retrospectively analyzed. Applying layer-systematic criteria 21 eyes after deep sclerectomy with scleral implant (SKGEL/Corneal or T-flux/I-Tech) were selected into group I (DS implant) and 23 eyes after phacoemulsification with simultaneously performed deep sclerectomy and scleral implants were selected into group II (FDS implant). In control studies best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber and fundus, were examined. Postoperative complications and applied procedures were analyzed especially controlling hypotensive effect (goniopuncture, antimetabolites), as well as number of glaucoma medications used. Tests were performed in 1 and 7 days after surgery, and later after 1, 3, 6, 12 months. Statistically test U Mann-Whitney was used as well as pair sequence Wilcoxon test. Survival analysis was done with Kaplan-Meier method with the use of log rank test.

RESULTS

After 360 days of observation mean values of IOP in group I was 14.3 +/- 3.6 mmHg, and in group II--12.9 +/- 3.0 mmHg. It was a decrease of mean IOP by 29.6% (p = .000) and 41.4% (p = .000) in comparison to preoperative IOP in particular groups. In both groups fewer glaucoma medications were used after surgery and the results were statistically significant (p < .05). As a complete success rate was considered IOP of < or =18 mmHg without glaucoma medications, and qualified success rate was IOP of < or =18 mmHg without medications or with the most of two glaucoma medications. Complete and qualified success rate were achieved respectively in group I (72.6% and 88.4%) and in group II (74.3% and 86.9%) at the end of observation. In the entire observation there were no statistically significant differences between group I and 2 (p > .05). After 360 days of observation there was no statistically significant difference between mean BCVA in group I and II (p > .05).

CONCLUSIONS

DS with scleral implant performed as a single procedure or FDS is effective treatment in open-angle glaucoma.

摘要

目的

基于年度观察，比较非穿透性深层巩膜切除术（DS）作为唯一手术方式与联合超声乳化术的手术（FDS）治疗开角型青光眼患者的有效性。

材料与方法

回顾性分析67例开角型青光眼患者的眼部情况。采用分层系统标准，将21例行深层巩膜切除联合巩膜植入术（SKGEL/角膜或T-flux/I-Tech）的患者纳入I组（DS植入组），23例行超声乳化术同时进行深层巩膜切除和巩膜植入术的患者纳入II组（FDS植入组）。在对照研究中，检查最佳矫正视力（BCVA）、眼压（IOP）、前房和眼底情况。分析术后并发症及应用的手术操作，尤其关注降压效果（房角穿刺、抗代谢药物）以及青光眼药物的使用数量。术后1天、7天以及之后的1、3、6、12个月进行相关检查。采用U Mann-Whitney统计检验以及配对序列Wilcoxon检验。使用Kaplan-Meier方法并结合对数秩检验进行生存分析。

结果

观察360天后，I组眼压平均值为14.3±3.6 mmHg，II组为12.9±3.0 mmHg。与术前眼压相比，I组眼压平均下降了29.6%（p = .000），II组下降了41.4%（p = .000）。两组术后使用的青光眼药物均减少，结果具有统计学意义（p < .05）。将眼压≤18 mmHg且无需使用青光眼药物视为完全成功率，眼压≤18 mmHg且无需使用药物或最多使用两种青光眼药物视为合格成功率。观察结束时，I组的完全成功率和合格成功率分别为72.6%和88.4%，II组分别为74.3%和86.9%。在整个观察过程中，I组和II组之间无统计学显著差异（p > .05）。观察360天后，I组和II组的平均BCVA无统计学显著差异（p > .05）。