Kolomeyer Anton M, Fechtner Robert D, Zarbin Marco A, Bhagat Neelakshi
The Institute of Ophthalmology and Visual Science, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey 07013, USA.
Eur J Ophthalmol. 2012 Jan-Feb;22(1):90-4. doi: 10.5301/ejo.5000027.
To describe a case series of combined 23-gauge vitrectomy and pars plana Baerveldt tube insertion for intraocular pressure (IOP) control in eyes with glaucoma resistant to maximum tolerated medical therapy and/or having failed previous IOP-lowering procedures.
Eight consecutive patients (8 eyes) undergoing a combined procedure were identified and included in this study. Outcome measures included preoperative and final best-corrected visual acuity (VA), IOP, number of glaucoma medications, and complications. Changes in IOP and glaucoma medications were compared by a paired t test. A Kaplan-Meier survival curve was constructed to evaluate IOP control as a function of time.
Mean patient age was 70.9 years while the mean follow-up time was 12.1 months. Open angle glaucoma was diagnosed in 5 (68%) eyes. Six (75%) eyes were pseudophakic. All eyes received a 250-mm(2) pars plana Baerveldt tube. Vision remained the same or improved in 6 (75%) eyes. Mean preoperative IOP and number of glaucoma medications were significantly (p<0.05) reduced by the combined procedure. Visual acuity of 5 (63%) eyes improved or remained unchanged. Six (75%) eyes encountered minor complications not requiring a return to the operating room. One (13%) eye underwent drainage of hemorrhagic choroidals on postoperative day 12.
A combined 23-gauge vitrectomy and pars plana Baerveldt tube insertion could be considered a useful procedure in reducing IOP and the number of glaucoma medications in eyes with refractory glaucoma.
描述一系列采用23G玻璃体切除术联合巩膜瓣下植入Baerveldt引流管来控制眼压（IOP）的病例，这些病例为对最大耐受药物治疗无效和/或先前降低眼压手术失败的青光眼患者。
本研究纳入了连续8例接受联合手术的患者（8只眼）。观察指标包括术前及最终的最佳矫正视力（VA）、眼压、青光眼药物使用数量及并发症。采用配对t检验比较眼压和青光眼药物使用情况的变化。绘制Kaplan-Meier生存曲线来评估眼压控制与时间的关系。
患者平均年龄为70.9岁，平均随访时间为12.1个月。5只眼（68%）诊断为开角型青光眼。6只眼（75%）为人工晶状体眼。所有眼睛均植入了250平方毫米的巩膜瓣下Baerveldt引流管。6只眼（75%）视力保持不变或提高。联合手术使术前平均眼压和青光眼药物使用数量显著降低（p<0.05）。5只眼（63%）的视力提高或保持不变。6只眼（75%）出现轻微并发症，无需再次手术。1只眼（13%）在术后第12天进行了出血性脉络膜引流。
23G玻璃体切除术联合巩膜瓣下植入Baerveldt引流管可被视为降低难治性青光眼患者眼压和减少青光眼药物使用数量的有效方法。
