改良深层巩膜切除术联合或不联合外路小梁切除术：一项对比研究。

A modified deep sclerectomy with or without external trabeculectomy: a comparative study.

作者信息

Kitsos George, Aspiotis Miltiades, Alamanos Yannis, Psilas Konstantinos

机构信息

Department of Ophthalmology, Medical School, University of Ioannina, Ioannina, Greece.

出版信息

Clin Ophthalmol. 2010 Jun 24;4:557-64. doi: 10.2147/opth.s10350.

DOI:10.2147/opth.s10350

PMID:20596510

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2893765/

Abstract

PURPOSE

To determine whether the removal of the inner wall of Schlemm's canal (external trabeculectomy) improves the effectiveness of a modified method of deep sclerectomy (DS), which we will call "reversed" deep sclerectomy (RDS).

MATERIALS AND METHOD

We conducted a prospective study of two groups of patients. Group A included 22 eyes of 18 patients with open angle glaucoma (OAG) under maximum medical treatment, which underwent RDS - a modified method of performing DS - with the removal of the inner wall of Schlemm's canal (external trabeculectomy) and without using any implant. Group B included 20 eyes of 17 patients which had undergone RDS alone. Demographic and tonometric data of patients of Group A revealed no significant difference from data of patients in Group B. A mean follow up period for Group A was 22.8 months and for Group B was 23.4 months. The outcome of the operations was termed a total success when intraocular pressure (IOP) was <21 mmHg postoperatively, without additional treatment, relative success when IOP was <21 mmHg with additional treatment and a total failure when IOP >21 mmHg with medical treatment.

RESULTS

Total success was achieved in 18/22 eyes (81.8%) for Group A and in 8/20 eyes (40%) for Group B (P < 0.05). Relative success was achieved in 22/22 (100%) for Group A and in 17/20 eyes (85%) in Group B (P = NS). Total failure occurred in 0/22 eyes (0%) in Group A and in 3/20 (15%) eyes in Group B (P = NS). The mean postoperative IOP in Group A was 13.5 +/- 2.8 mmHg with a reduction of 12.4 +/- 4.6 mmHg (48.1%) and in Group B mean postoperative IOP was 18 +/- 4.3 mmHg with a reduction of 6.2 +/- 6.9 (25.6%) (P < 0.001). Mean drug reduction postoperatively was 3.2 +/- 0.9 drugs in Group A and 1.7 +/- 1.2 in Group B (P < 0.001).

CONCLUSION

In the follow up time during which the two groups were under study (12-36 months), the removal of the inner wall of Schlemm's canal while performing RDS proves an important factor in improving its effectiveness.

摘要

目的

确定切除施莱姆管内壁（外路小梁切除术）是否能提高改良深层巩膜切除术（DS）（我们称之为“反向”深层巩膜切除术，即RDS）的有效性。

材料与方法

我们对两组患者进行了前瞻性研究。A组包括18例接受最大药物治疗的开角型青光眼（OAG）患者的22只眼，这些眼睛接受了RDS（一种改良的DS手术方法），即切除施莱姆管内壁（外路小梁切除术）且未使用任何植入物。B组包括17例患者的20只眼，这些眼睛仅接受了RDS。A组患者的人口统计学和眼压数据与B组患者的数据相比无显著差异。A组的平均随访期为22.8个月，B组为23.4个月。当术后眼压（IOP）<21 mmHg且无需额外治疗时，手术结果称为完全成功；当IOP<21 mmHg但需额外治疗时，称为相对成功；当经药物治疗后IOP>21 mmHg时，称为完全失败。

结果

A组22只眼中有18只（81.8%）获得完全成功，B组20只眼中有8只（40%）获得完全成功（P<0.05）。A组22只眼全部（100%）获得相对成功，B组20只眼中有17只（85%）获得相对成功（P=无显著性差异）。A组22只眼中无（0%）发生完全失败，B组20只眼中有3只（15%）发生完全失败（P=无显著性差异）。A组术后平均眼压为13.5±2.8 mmHg，降低了12.4±4.6 mmHg（48.1%），B组术后平均眼压为18±4.3 mmHg，降低了6.2±6.9（25.6%）（P<0.001）。A组术后平均药物减少量为3.2±0.9种药物，B组为1.7±1.2种药物（P<0.001）。