Glaucoma Service and Dana Center for Preventive Ophthalmology, Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Ophthalmology. 2012 Apr;119(4):712-22. doi: 10.1016/j.ophtha.2011.09.049. Epub 2012 Jan 14.
To determine rates of success and complications of trabeculectomy surgery.
Case series.
Consecutive patients undergoing trabeculectomy by 2 surgeons between May 2000 and October 2008.
By using the Wilmer Institute's billing database, we identified all patients at least 12 years of age coded as having undergone trabeculectomy between May 2000 and October 2008 by 1 of 2 glaucoma surgeons and whose surgery was not combined with another operation. From the chart, we abstracted demographic information on the patients and clinical characteristics of the eyes. The Kaplan-Meier product-limit method and Cox proportional hazard models were used to look at success rates and characteristics associated with inadequate intraocular pressure (IOP) reduction. Complications were tabulated.
(1) Success rate of trabeculectomy, as determined by the achievement of each of 4 different IOP goals, with or without IOP-lowering medications; and (2) incidence of surgical complications.
During the study period, 797 eyes of 634 persons underwent trabeculectomy without concurrent surgery. The success rates 4 years after surgery, with or without the use of IOP-lowering eye drops, were 70%, 72%, 60%, and 44%, for achievement of target IOP, ≤18 mmHg and ≥20% IOP reduction, ≤15 mmHg and ≥25% reduction, and ≤12 mmHg and ≥30% reduction, respectively. Increased chance of success was associated with European-derived race; use of mitomycin C (MMC); higher concentrations of MMC, when used; and higher preoperative IOP. Age and previous intraocular surgery were not associated with surgical success. Complications included worsening lens opacity in 242 of 443 phakic eyes (55%), loss of ≥3 lines of acuity (Snellen) in 161 eyes (21%), surgery for bleb-related problems in 70 eyes (8.8%), and infection occurring >6 weeks after surgery in 27 eyes (3.4%). A total of 101 eyes of 94 patients had at least 1 subsequent operation for inadequate IOP control.
Trabeculectomy surgery performed by 2 experienced glaucoma specialists achieved target IOP at 4 years in 70% of those operated and was associated with progressive cataract and small risks of bleb-related complications. These results are comparable to those reported in smaller series.
确定小梁切除术的成功率和并发症。
病例系列。
2000 年 5 月至 2008 年 10 月期间由 2 位外科医生连续进行小梁切除术的患者。
通过使用威尔默眼科研究所的计费数据库，我们确定了所有至少 12 岁的患者，他们在 2000 年 5 月至 2008 年 10 月期间由 1 位或 2 位青光眼外科医生编码为接受小梁切除术，且手术未与其他手术联合进行。从图表中，我们提取了患者的人口统计学信息和眼部临床特征。使用 Kaplan-Meier 乘积限法和 Cox 比例风险模型来观察成功率和与眼压降低不足相关的特征。列出了并发症。
（1）达到 4 种不同眼压目标的小梁切除术成功率，包括有无眼压降低药物；（2）手术并发症发生率。
在研究期间，797 只眼的 634 人在未进行联合手术的情况下接受了小梁切除术。术后 4 年，不使用或使用眼压降低眼药水时，达到目标眼压、≤18mmHg 和眼压降低≥20%、≤15mmHg 和眼压降低≥25%、和≤12mmHg 和眼压降低≥30%的成功率分别为 70%、72%、60%和 44%。增加手术成功率的因素包括欧洲裔种族；使用丝裂霉素 C（MMC）；使用的 MMC 浓度较高；以及较高的术前眼压。年龄和既往眼内手术与手术成功率无关。并发症包括 443 只未植入晶状体的眼中 242 只（55%）晶状体混浊加重，161 只眼（21%）视力丧失≥3 行（Snellen），70 只眼（8.8%）因与滤过泡相关的问题而进行手术，27 只眼（3.4%）术后 6 周以上发生感染。94 例患者中有 101 例因眼压控制不足至少进行了 1 次后续手术。
由 2 位经验丰富的青光眼专家进行的小梁切除术，在 4 年内达到目标眼压的患者占 70%，与进行性白内障和小风险的滤过泡相关并发症相关。这些结果与较小系列的报告相似。
