Shoji Takuhei, Tanito Masaki, Takahashi Hirokazu, Park Masami, Hayashi Ken, Sakurai Yutaka, Nishikawa Shimpei, Chihara Etsuo
Sensho-kai Eye Institute, Kyoto, and the Department of Ophthalmology, Shimane University School of Medicine, Shimane, Japan.
J Cataract Refract Surg. 2007 Jul;33(7):1209-16. doi: 10.1016/j.jcrs.2007.03.027.
To compare the midterm efficacy and safety of phacoviscocanalostomy (viscocanalostomy, phacoemulsification, and intraocular lens [IOL] implantation) and cataract surgery (phacoemulsification and IOL implantation) in patients with normal-tension glaucoma (NTG) and cataract.
Sensho-kai Eye Institute, Kyoto, Japan.
Thirty-one eyes had phacoviscocanalostomy, and 35 eyes had uncomplicated cataract surgery only. The intraocular pressure (IOP), postoperative antiglaucoma medications, and visual outcomes were compared between groups.
The mean follow-up was 34.9 months+/-19.8 (SD) (range 7 to 78 months). At 36 months, the mean preoperative IOP and postoperative IOP were 17.2+/-1.5 mm Hg and 14.1+/-1.6 mm Hg, respectively, in the phacoviscocanalostomy group and 16.7+/-1.4 mm Hg and 15.6+/-3.4 mm Hg, respectively, in the cataract surgery only group. The differences between groups were significant at all time points (P<.05). The success probabilities of the phacoviscocanalostomy group achieving 20% and 30% IOP reductions with (or without) medications were 78.5% (67.4%) and 35.5% (37.4%) at 24 months and 58.0% (44.2%) and 28.0% (26.6%) at 48 months, which were significantly better than the probabilities in the cataract surgery only group, which were 16.0% (9.5%) and 5.7% (2.9%) at 24 months (P<.001 for each comparison, Kaplan-Meier life-table analysis with log-rank test). Based on the modified Aulhorn-Greve classification, the visual acuity and visual fields did not deteriorate in the phacoviscocanalostomy group; the visual fields deteriorated in 6 eyes in the cataract surgery only group during the follow-up (P=.024).
Phacoviscocanalostomy lowered IOP and maintained postoperative visual outcomes; it was safe and effective in elderly patients with coexisting NTG and cataract.
比较超声乳化小梁切开术（粘小管切开术、超声乳化及人工晶状体[IOL]植入）与白内障手术（超声乳化及IOL植入）治疗正常眼压性青光眼（NTG）合并白内障患者的中期疗效及安全性。
日本京都千祥会眼科研究所。
31只眼接受了超声乳化小梁切开术，35只眼仅接受了单纯白内障手术。比较两组的眼压（IOP）、术后抗青光眼药物使用情况及视力结果。
平均随访时间为34.9个月±19.8（标准差）（范围7至78个月）。在36个月时，超声乳化小梁切开术组术前平均IOP和术后IOP分别为17.2±1.5 mmHg和14.1±1.6 mmHg，单纯白内障手术组分别为16.7±1.4 mmHg和15.6±3.4 mmHg。两组在所有时间点的差异均有统计学意义（P<0.05）。超声乳化小梁切开术组在24个月时使用（或不使用）药物使IOP降低20%和30%的成功概率分别为78.5%（67.4%）和35.5%（37.4%），在48个月时分别为58.0%（44.2%）和28.0%（26.6%），显著优于单纯白内障手术组在24个月时的概率16.0%（9.5%）和5.7%（2.9%）（每次比较P<0.001，采用对数秩检验的Kaplan-Meier生存表分析）。根据改良的奥霍恩-格雷夫分类法，超声乳化小梁切开术组的视力和视野未恶化；单纯白内障手术组在随访期间有6只眼的视野恶化（P=0.024）。
超声乳化小梁切开术可降低眼压并维持术后视力结果；对合并NTG和白内障的老年患者安全有效。
