Division of Ophthalmology, Department of Clinical Neurosciences, University Hospitals of Geneva, Switzerland.
J Glaucoma. 2012 Aug;21(6):408-14. doi: 10.1097/IJG.0b013e31822089b5.
To evaluate the influence of learning curve on the surgical outcome of viscocanalostomy.
Retrospective, interventional study. Chart review of the first consecutive open-angle glaucoma cases that received viscocanalostomy in 1 institution between July 1996 and June 2000. Overall success was defined as no visual field deterioration; postoperative intraocular pressure (IOP) ≤20 mm Hg; and IOP reduction ≥30% compared with baseline values with or without medication. When medications were not required, success was defined as complete. Demographic, procedural, and postoperative data were tabulated and analyzed.
overall and complete success rates.
number of glaucoma medications and surgical complications.
A total of 180 cases were analyzed. Mean follow-up (±SD) was 28.9±5.9 months (range, 12-36 mo). Overall success has significantly improved from 64% to 91% when comparing the first 45 to the last 45 cases of the series (Mantel-Cox, P=0.005). Similarly, complete success has significantly improved from 38% to 73% (Mantel-Cox, P=0.004). The mean number of glaucoma medication (±SD) significantly decreased from 2.58±0.94 before surgery to 0.53±0.79 after surgery (Wilcoxon, P<0.001). Surgical complications decreased from 16 in the first 45 cases to 10 in the last 45 cases without reaching statistical significance (Pearson χ, P=0.315).
Viscocanalostomy appears to safely reduce IOP in cases with medically uncontrolled open-angle glaucoma. Mastering viscocanalostomy procedure is achievable after the first 40 cases.
评估学习曲线对粘小管切开术手术效果的影响。
回顾性、干预性研究。对 1996 年 7 月至 2000 年 6 月期间在 1 家机构内接受粘小管切开术的连续开角型青光眼病例的首次回顾性研究。总体成功定义为无视野恶化；术后眼压（IOP）≤20mmHg；与基线值相比，IOP 降低≥30%，无需药物治疗。当无需药物治疗时，定义为完全成功。对人口统计学、手术过程和术后数据进行制表和分析。
总成功率和完全成功率。
青光眼药物使用数量和手术并发症。
共分析了 180 例病例。平均随访时间（±SD）为 28.9±5.9 个月（范围，12-36 个月）。当比较该系列前 45 例和后 45 例时，总体成功率从 64%显著提高到 91%（Mantel-Cox，P=0.005）。同样，完全成功率从 38%显著提高到 73%（Mantel-Cox，P=0.004）。手术前平均青光眼药物使用数量（±SD）从 2.58±0.94 显著减少到术后的 0.53±0.79（Wilcoxon，P<0.001）。手术并发症从前 45 例的 16 例减少到后 45 例的 10 例，但无统计学意义（Pearson χ，P=0.315）。
粘小管切开术似乎可以安全降低药物控制不佳的开角型青光眼的眼压。在前 40 例手术后可以掌握粘小管切开术的操作。
