Wishart Peter K, Wishart Manijeh S, Choudhary Anshoo, Grierson Ian
St. Paul's Eye Unit, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK.
Clin Exp Ophthalmol. 2008 Mar;36(2):148-55. doi: 10.1111/j.1442-9071.2008.01702.x.
To document the outcome of viscocanalostomy (VC) alone or combined with phacoemulsification (phaco-VC) in eyes with pseudoexfoliation glaucoma (PEXG) and primary open angle glaucoma (POAG).
A prospective, comparative study of 314 eyes undergoing VC in two centres over 6 years was conducted. Main outcome measures were: (i) intraocular pressure (IOP) control (complete success was IOP < or = 18 mmHg without medication and failure IOP > 18 mmHg); and (ii) requirement for Nd:YAG laser goniopuncture (YAG-GP) if IOP > 21 mmHg.
In the POAG group, 174 eyes underwent phaco-VC and 104 VC. In the PEX group, 20 eyes underwent phaco-VC and 16 VC. At final follow up, complete success rate (CSR) was 76% for POAG phaco-VC, 67% for POAG VC, 95% for PEXG phaco-VC and 63% for PEXG VC with mean IOP reduction of 29.9%, 40%, 42.5% and 51%, respectively. Without YAG-GP, by 3 years postoperatively the failure rate was 100% for PEXG eyes and 21% for POAG eyes undergoing VC alone, but PEXG eyes undergoing phaco-VC were 100% successful. CSR for YAG-GP was 92% in PEXG VC eyes and 55% in POAG VC eyes.
In phakic eyes with PEXG undergoing VC, an absolute requirement for long-term success was YAG-GP. This was not the case in POAG eyes or PEXG eyes undergoing phaco-VC. Late IOP rise in phakic PEXG eyes and restoration of IOP control following YAG-GP suggests that continued release of PEX material from the lens capsule with time blocks the outflow through the trabecular-Descemetic window created by VC.
记录单纯小梁切开术（VC）或联合超声乳化术（超声乳化 - VC）治疗剥脱性青光眼（PEXG）和原发性开角型青光眼（POAG）患眼的治疗效果。
在两个中心进行了一项为期6年的前瞻性比较研究，纳入314例行小梁切开术的患眼。主要观察指标为：（i）眼压（IOP）控制情况（完全成功定义为未使用药物时眼压≤18 mmHg，失败定义为眼压＞18 mmHg）；（ii）若眼压＞21 mmHg，Nd:YAG激光房角穿刺术（YAG - GP）的需求情况。
在POAG组中，174眼行超声乳化 - VC，104眼行小梁切开术。在PEXG组中，20眼行超声乳化 - VC，16眼行小梁切开术。末次随访时，POAG超声乳化 - VC的完全成功率（CSR）为76%，POAG小梁切开术为67%，PEXG超声乳化 - VC为95%，PEXG小梁切开术为63%，平均眼压分别降低29.9%、40%、42.5%和51%。未行YAG - GP时，术后3年，单纯行小梁切开术的PEXG患眼失败率为100%，POAG患眼为21%，但行超声乳化 - VC的PEXG患眼成功率为100%。PEXG小梁切开术行YAG - GP的CSR为92%，POAG小梁切开术为55%。
在接受小梁切开术的有晶状体PEXG患眼中，YAG - GP是长期成功的绝对必要条件。在POAG患眼或接受超声乳化 - VC的PEXG患眼中并非如此。有晶状体PEXG患眼眼压后期升高以及YAG - GP后眼压控制恢复提示，随着时间推移，晶状体囊膜持续释放PEX物质会阻塞通过小梁 - 后弹力层窗（由小梁切开术创建）的房水流出。
