Liu Lance, Siriwardena Dilani, Khaw Peng Tee
Glaucoma Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
J Glaucoma. 2008 Sep;17(6):423-30. doi: 10.1097/IJG.0b013e31816224d8.
To assess the pattern of use of antimetabolites and steroids in trabeculectomy surgery among consultant ophthalmologists in Australia and New Zealand.
A postal questionnaire of 25 questions regarding current glaucoma practices and antimetabolite and steroid use in trabeculectomy surgery was sent to all practicing Australian and New Zealand Fellows of the Royal Australia and New Zealand College of Ophthalmologists in July 2005. The second half of the survey consisted of questions on the number of trabeculectomies performed per year, topical steroid use, the type of antimetabolite used, and assessment of factors that may influence the decision to use them. The results were cross-tabulated according to state/country, years practicing, type of practice, and being a glaucoma subspecialist (GSS).
The overall response rate was 78% (627 out of 808). Ninety-one percent stated that they managed glaucoma of which 65% stated that they perform trabeculectomy surgery and 16% considered themselves as a GSS. In 2004, 75% of ophthalmologists performed less than 10 trabeculectomies. Sixty-one percent used an antimetabolite in trabeculectomy surgery of which 5-fluorouracil was used 51% (intraoperatively) and 24% (postoperatively). Mitomycin C was used in 12% and 0.2 mg/mL was the most commonly used concentration for 2 or 3 minutes. Fifty-four percent used postoperative steroids in a primary trabeculectomy for 1 to 2 months with 48% of GSSs using it for 2 to 3 months. Forty-eight percent to 96% would use an antimetabolite in patients with risk factors for conjunctival scarring.
This survey shows a wide range of the use of antimetabolites and steroids in trabeculectomy surgery with 5-fluorouracil being most commonly used. GSSs and young ophthalmologists would use antimetabolites more often and postoperative steroids for longer. This survey allows ophthalmologists to compare their own practices with those of their colleagues in Australia and the United Kingdom.
评估澳大利亚和新西兰眼科顾问医生在小梁切除术手术中抗代谢药物和类固醇的使用模式。
2005年7月，向所有澳大利亚和新西兰皇家眼科医学院的在职研究员发送了一份包含25个问题的邮政调查问卷，内容涉及当前青光眼治疗方法以及小梁切除术手术中抗代谢药物和类固醇的使用情况。调查的后半部分包括关于每年进行小梁切除术的数量、局部类固醇的使用、所使用抗代谢药物的类型以及对可能影响使用决策的因素的评估等问题。结果根据州/国家、从业年限、执业类型以及是否为青光眼专科医生（GSS）进行交叉制表。
总体回复率为78%（808人中627人回复）。91%的人表示他们治疗青光眼，其中65%的人表示他们进行小梁切除术手术，16%的人认为自己是青光眼专科医生。2004年，75%的眼科医生进行的小梁切除术少于10例。61%的人在小梁切除术手术中使用抗代谢药物，其中5 - 氟尿嘧啶的使用率为51%（术中）和24%（术后）。丝裂霉素C的使用率为12%，最常用的浓度为0.2mg/mL，使用时间为2或3分钟。54%的人在初次小梁切除术中术后使用类固醇1至2个月，48%的青光眼专科医生使用2至3个月。48%至96%的人会在有结膜瘢痕形成危险因素的患者中使用抗代谢药物。
本次调查显示小梁切除术手术中抗代谢药物和类固醇的使用情况差异很大，5 - 氟尿嘧啶使用最为普遍。青光眼专科医生和年轻眼科医生更常使用抗代谢药物，术后使用类固醇的时间更长。本次调查使眼科医生能够将自己的治疗方法与澳大利亚和英国的同行进行比较。
