小梁切除术后低眼压。

Hypotony following trabeculectomy.

机构信息

Doheny Eye Institute and the Department of Ophthalmology, University of Southern California School of Medicine, Los Angeles, California, U.S.A.

出版信息

J Glaucoma. 1995 Apr;4(2):73-9.

PMID:19920649

Abstract

OBJECTIVE

To determine the risk factors for development of postoperative hypotony and the effects of hypotony on the outcome of surgery in terms of intraocular pressure (IOP) control and final visual acuity in patients who underwent standard trabeculectomy, trabeculectomy with postoperative 5-fluorouracil injections, trabeculectomy with intraoperative mitomycin-C, or trabeculectomy with both antimetabolites.

PATIENTS AND DESIGN

We retrospectively reviewed the outcome in 155 eyes of 155 patients who underwent standard trabeculectomy (n = 15), trabeculectomy with postoperative 5-fluorouracil injections (n = 81), trabeculectomy with intraoperative mitomycin-C (n = 55), or trabeculectomy with both antimetabolites (n = 4).

RESULTS

Hypotony developed in 108 (69.6%) eyes (IOP < 6 mm Hg) at some point postoperatively; this was transient (< 14 days) in 75 eyes, and prolonged (> 14 days) in 33 eyes. The positive preoperative factors for the development of prolonged hypotony were young age, myopia, and preoperative use of carbonic anhydrase inhibitor. The mean age of patients in whom prolonged hypotony developed was 57.3 +/- 18.3 years (compare the mean age without prolonged hypotony, 65.3 +/- 14.5 years, p = 0.02). Sixteen of 33 (48%) patients in whom prolonged hypotony developed were myopic (p = 0.02), and 23 of 33 (70%) patients in whom prolonged hypotony developed used preoperative carbonic anhydrase inhibitor (p = 0.07).

CONCLUSIONS

There was no difference in the incidence of hypotony between patients who received 5-fluorouracil and those who received mitomycin-C. Postoperative hypotony was associated with three types of postoperative complications: shallow anterior chamber, choroidal detachment, and hypotony maculopathy (p = 0.02, 0.000, and 0.05, respectively). Hypotony did not have any effect on the success of surgery in terms of IOP control, but did have an effect on the visual outcome. Fourteen of the 33 patients (42.4%) in whom prolonged hypotony developed had worse visual acuity (p = 0.002); of these cases, four were due to hypotony maculopathy.

摘要

目的

确定术后低眼压的危险因素，以及低眼压对标准小梁切除术、术后氟尿嘧啶注射小梁切除术、术中丝裂霉素 C 小梁切除术或两种抗代谢物小梁切除术患者眼压控制和最终视力结局的影响。

患者和设计

我们回顾性分析了 155 例 155 只眼的结果，其中包括标准小梁切除术（n = 15）、术后氟尿嘧啶注射小梁切除术（n = 81）、术中丝裂霉素 C 小梁切除术（n = 55）或两种抗代谢物小梁切除术（n = 4）。

结果

108 只眼（69.6%）术后出现低眼压（眼压<6mmHg）；75 只眼为短暂性（<14 天），33 只眼为持续性（>14 天）。持续性低眼压发生的术前阳性因素为年龄较小、近视和术前使用碳酸酐酶抑制剂。持续性低眼压患者的平均年龄为 57.3±18.3 岁（无持续性低眼压患者的平均年龄为 65.3±14.5 岁，p = 0.02）。33 例持续性低眼压患者中 16 例（48%）为近视（p = 0.02），33 例持续性低眼压患者中 23 例（70%）术前使用碳酸酐酶抑制剂（p = 0.07）。

结论

接受氟尿嘧啶和丝裂霉素 C 的患者低眼压发生率无差异。术后低眼压与三种术后并发症有关：浅前房、脉络膜脱离和低眼压性黄斑病变（p = 0.02、0.000、0.05）。低眼压对眼压控制手术成功率没有影响，但对视功能有影响。33 例持续性低眼压患者中 14 例（42.4%）视力较差（p = 0.002），其中 4 例是由于低眼压性黄斑病变。