Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA.
Ophthalmology. 2012 Jan;119(1):36-42. doi: 10.1016/j.ophtha.2011.06.046. Epub 2011 Oct 7.
To compare the effect of ab interno trabeculectomy with trabeculectomy.
Retrospective, cohort study.
A total of 115 patients who underwent ab interno trabeculectomy (study group) compared with 102 patients who underwent trabeculectomy with intraoperative mitomycin as an initial surgical procedure (trabeculectomy group). Inclusion criteria were open-angle glaucoma, age ≥ 40 years, and uncontrolled on maximally tolerated medical therapy. Exclusion criterion was concurrent surgery.
Clinical variables were collected from patient medical records.
Intraocular pressure (IOP) and Cox proportional hazard ratio (HR) and Kaplan-Meier survival analyses with failure defined as IOP >21 mmHg or less than 20% reduction below baseline on 2 consecutive follow-up visits after 1 month; IOP ≤ 5 mmHg on 2 consecutive follow-up visits after 1 month; additional glaucoma surgery; or loss of light perception vision. Secondary outcome measures include number of glaucoma medications and occurrence of complications.
Mean follow-up was 27.3 and 25.5 months for the study and trabeculectomy groups, respectively. Intraocular pressure decreased from 28.1 ± 8.6 mmHg at baseline to 15.9 ± 4.5 mmHg (43.5% reduction) at month 24 in the study group, and from 26.3 ± 10.9 mmHg at baseline to 10.2 ± 4.1 mmHg (61.3% reduction) at month 24 in the trabeculectomy group. The success rates at 2 years were 22.4% and 76.1% in the study and trabeculectomy groups, respectively (P<0.001). Younger age (P = 0.037; adjusted HR, 0.98 per year; 95% confidence interval [CI], 0.97-0.99) and lower baseline IOP (P = 0.016; adjusted HR, 0.96 per 1 mmHg; 95% CI, 0.92-0.99) were significant risk factors for failure in the multivariate analysis of the study group. With the exception of hyphema, the occurrence of postoperative complications was more frequent in the trabeculectomy group (P<0.001). More additional glaucoma procedures were performed after ab interno trabeculectomy (43.5%) than after trabeculectomy (10.8%, P<0.001).
Ab interno trabeculectomy has a lower success rate than trabeculectomy.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
比较经内路小梁切开术与小梁切除术的效果。
回顾性队列研究。
共纳入 115 例接受经内路小梁切开术（研究组）的患者，并与 102 例接受术中丝裂霉素作为初始手术的小梁切除术（小梁切除术组）的患者进行比较。纳入标准为开角型青光眼，年龄≥40 岁，最大耐受药物治疗后仍未得到控制。排除标准为同时行其他手术。
从患者病历中收集临床变量。
眼压（IOP）和 Cox 比例风险比（HR）及 Kaplan-Meier 生存分析，失访定义为：术后 1 个月连续 2 次随访时 IOP＞21mmHg 或较基线降低＜20%；术后 1 个月连续 2 次随访时 IOP≤5mmHg；需行其他青光眼手术；或光感丧失。次要观察指标包括降眼压药物的使用数量和并发症的发生情况。
研究组和小梁切除术组的平均随访时间分别为 27.3 和 25.5 个月。研究组患者的基线 IOP 为 28.1±8.6mmHg，至术后 24 个月时降至 15.9±4.5mmHg（降低 43.5%），小梁切除术组患者的基线 IOP 为 26.3±10.9mmHg，至术后 24 个月时降至 10.2±4.1mmHg（降低 61.3%）。术后 2 年时，研究组和小梁切除术组的成功率分别为 22.4%和 76.1%（P＜0.001）。多变量分析显示，年龄较小（P=0.037；调整 HR，每年 0.98；95%可信区间[CI]，0.97-0.99）和基线 IOP 较低（P=0.016；调整 HR，每降低 1mmHg 为 0.96；95%CI，0.92-0.99）是研究组患者失败的显著危险因素。除前房积血外，小梁切除术组患者术后并发症的发生更为频繁（P＜0.001）。经内路小梁切开术后需行其他降眼压手术的患者（43.5%）多于小梁切除术组（10.8%，P＜0.001）。
与小梁切除术相比，经内路小梁切开术的成功率较低。
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