Cotran Paul R, Roh Shiyoung, McGwin Gerald
Department of Ophthalmology, Lahey Clinic, Burlington, Massachusetts 01960, USA.
Ophthalmology. 2008 Mar;115(3):447-454.e1. doi: 10.1016/j.ophtha.2007.05.056. Epub 2007 Sep 6.
To compare intraocular pressure (IOP) control and other clinical outcomes after 1-site fornix-based and 2-site limbus-based phacotrabeculectomy.
Prospective randomized controlled trial.
A total of 90 eyes of 76 patients with cataract and glaucoma were treated.
Forty-four eyes were assigned randomly to receive a 1-site phacotrabeculectomy with a fornix-based conjunctival flap, and 46 eyes were assigned randomly to receive a 2-site phacotrabeculectomy with a limbus-based conjunctival flap. All operations were performed with mitomycin C.
Intraocular pressure and number of antiglaucoma medications were recorded at baseline and during a 3-year follow-up period.
Mean preoperative IOP was 20.1+/-3.8 mmHg in the 1-site group and 19.5+/-5.3 mmHg in the 2-site group (P = 0.56) using a mean of 2.3+/-0.9 and 2.5+/-0.9 antiglaucoma medications, respectively (P = 0.27). After 3 years of follow-up, the mean IOP was 12.6+/-4.8 mmHg in the 1-site group and 11.7+/-4.0 mmHg in the 2-site group (P = 0.40), receiving a mean of 0.3+/-0.7 and 0.4+/-0.9 medications, respectively (P = 0.59). At the end of the study, 73% of 1-site eyes and 78.4% of 2-site eyes had IOPs of less than 18 mmHg while receiving no antiglaucoma medications (P = 0.59). Visual acuity was similar for both groups at 3 months after surgery. There were no significant differences in the need for digital pressure, postoperative bleb needling with 5-fluorouracil, or number of postoperative visits. There were 2 major complications in each group during follow-up. Early leaks of the conjunctival wound closure occurred in 6 eyes in the 1-site group and in 0 eyes in the 2-site group (P = 0.03). Operating time (in minutes) was less in the 1-site surgery group (P<0.0001). Day one postoperative IOP was higher in the 2-site group (P = 0.0.01).
One-site fornix-based and 2-site limbus-based phacotrabeculectomy were similarly effective in lowering IOP and reducing the need for antiglaucoma medications over a 3-year follow-up period.
比较单部位穹窿部结膜瓣小梁切除术和双部位角膜缘部结膜瓣小梁切除术后的眼压控制情况及其他临床结果。
前瞻性随机对照试验。
76例白内障合并青光眼患者的90只眼接受治疗。
44只眼随机分配接受单部位穹窿部结膜瓣小梁切除术，46只眼随机分配接受双部位角膜缘部结膜瓣小梁切除术。所有手术均使用丝裂霉素C。
记录基线时及3年随访期间的眼压和抗青光眼药物使用数量。
单部位组术前平均眼压为20.1±3.8 mmHg，双部位组为19.5±5.3 mmHg（P = 0.56），分别平均使用2.3±0.9和2.5±0.9种抗青光眼药物（P = 0.27）。随访3年后，单部位组平均眼压为12.6±4.8 mmHg，双部位组为11.7±4.0 mmHg（P = 0.40），分别平均使用0.3±0.7和0.4±0.9种药物（P = 0.59）。研究结束时，单部位组73%的眼和双部位组78.4%的眼在未使用抗青光眼药物时眼压低于18 mmHg（P = 0.59）。两组术后3个月时视力相似。在指压需求、术后用5-氟尿嘧啶进行滤泡针刺或术后就诊次数方面无显著差异。随访期间每组有2例主要并发症。单部位组6只眼发生结膜伤口闭合早期渗漏，双部位组0只眼发生（P = 0.03）。单部位手术组手术时间（分钟）较短（P<0.0001）。双部位组术后第1天眼压较高（P = 0.01）。
在3年随访期内，单部位穹窿部结膜瓣小梁切除术和双部位角膜缘部结膜瓣小梁切除术在降低眼压和减少抗青光眼药物使用需求方面效果相似。
