Kayikcioglu Ozcan R, Emre Sinan, Kaya Ziya
Department of Ophthalmology, School of Medicine, Celal Bayar University, 45010, Manisa, Turkey.
Int Ophthalmol. 2010 Jun;30(3):271-7. doi: 10.1007/s10792-009-9326-7. Epub 2009 Dec 4.
The objective of this study was to investigate the efficacy and safety of trabeculectomy combined with deep sclerectomy in patients with primary open angled glaucoma (POAG) and to compare the results with those from conventional trabeculectomy. In the study 12 eyes of 10 patients operated with trabeculectomy combined with deep sclerectomy (Group I) and 16 eyes of 16 patients operated with conventional trabeculectomy surgery (Group II) were included. In the described form of combined deep sclerectomy with the trabeculectomy technique the superficial scleral flap was sutured with 10/0 monofilament, the number and tension of sutures were adjusted according to the outflow dynamics, under the scleral flap, of balanced salt solution (BSS) provided by an anterior chamber maintainer. In groups I and II all the patients were male POAG cases with mean ages of 60.0 +/- 19.4 and 67.0 +/- 7.1 years, respectively. The mean follow-up periods were 8.3 +/- 3.5 months for group I and 16.6 +/- 7.0 months for group II. Preoperative mean IOP were 29.7 +/- 8.3 and 29.1 +/- 12.8 mmHg mmHg, and average topical antiglaucomatous medications were 2.9 +/- 0.7 and 2.7 +/- 1.1 for groups I and II, respectively. Postoperatively mean IOP measurements were reduced in groups I and II to 10.5 +/- 2.9 vs. 9.6 +/- 4.8 mmHg at 1 week, 13.7 +/- 5.6 vs. 16.0 +/- 9.8 at 1st month, 12.3 +/- 6.4 vs. 17.3 +/- 8.0 at 3rd month, 11.0 +/- 4.1 vs. 15.3 +/- 5.8 at 6th month, 10.8 +/- 1.6 vs. 16.1 +/- 4.4 at 12th month, and 11.0 +/- 1.0 vs. 16.7 +/- 5.0 at 18th month. Statistical analysis revealed that mean postoperative IOP measurements for group I were significantly lower than for group II for all measurements except the first week (P < 0.05). At 12th month, the complete (IOP <22 mmHg without medication) and qualified (IOP <22 mmHg with medication) success rates were 83.3 and 100% for group I and 63.6 and 90.9% for group II. Postoperatively at 12th month, the mean number of antiglaucoma medications had fallen to 0.0 +/- 0.0 in group I and 0.81 +/- 1.1 in group II. Trabeculectomy surgery combined with deep sclerectomy and suture adjustment under an anterior chamber maintainer provided sufficient IOP decrease and diffuse bleb morphology. This technique could be used as a safe method for management of glaucoma.
本研究的目的是探讨小梁切除术联合深层巩膜切除术治疗原发性开角型青光眼（POAG）的疗效和安全性，并将结果与传统小梁切除术的结果进行比较。本研究纳入了10例接受小梁切除术联合深层巩膜切除术的患者的12只眼（I组）和16例接受传统小梁切除术的患者的16只眼（II组）。在所述的深层巩膜切除术与小梁切除术联合技术中，表层巩膜瓣用10/0单丝缝合，缝线的数量和张力根据前房维持器提供的平衡盐溶液（BSS）在巩膜瓣下的流出动力学进行调整。I组和II组所有患者均为男性POAG病例，平均年龄分别为60.0±19.4岁和67.0±7.1岁。I组的平均随访期为8.3±3.5个月，II组为16.6±7.0个月。I组和II组术前平均眼压分别为29.7±8.3和29.1±12.8 mmHg，平均局部抗青光眼药物分别为2.9±0.7和2.7±1.1。术后I组和II组平均眼压测量值在第1周时分别降至10.5±2.9 vs. 9.6±4.8 mmHg，第1个月时为13.7±5.6 vs. 16.0±9.8，第3个月时为12.3±6.4 vs. 17.3±8.0，第6个月时为11.0±4.1 vs. 15.3±5.8，第12个月时为10.8±1.6 vs. 16.1±4.4，第18个月时为11.0±1.0 vs. 16.7±5.0。统计分析显示，除第1周外，I组术后所有测量的平均眼压测量值均显著低于II组（P<0.05）。在第12个月时，I组的完全（眼压<22 mmHg且无需用药）和合格（眼压<22 mmHg且需用药）成功率分别为83.3%和100%，II组为63.6%和90.9%。术后第12个月时，I组抗青光眼药物的平均数量降至0.0±0.0，II组为0.81±1.1。小梁切除术联合深层巩膜切除术并在前房维持器下进行缝线调整可使眼压充分降低并形成弥散性滤过泡形态。该技术可作为一种安全的青光眼治疗方法。
