Department of Ophthalmology and Visual Science, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, Japan.
Graefes Arch Clin Exp Ophthalmol. 2013 Mar;251(3):825-30. doi: 10.1007/s00417-012-2091-8. Epub 2012 Jun 29.
To evaluate long-term efficacy of goniosynechialysis (GSL) combined with phacoemulsification and intraocular lens implantation (phaco-GSL) for primary angle closure or primary angle-closure glaucoma (PAC/PACG) and to analyze risk factors for surgical outcomes.
We reviewed medical records of 109 eyes of 109 patients (mean [± SD] age 70 ± 9.4 years) who underwent phaco-GSL as primary treatment of PAC/PACG at five institutions. All eyes had a preoperative intraocular pressure (IOP) of ≥ 21 mmHg with or without medications. Surgical failure was defined as: (1) condition A: persistent IOP values of ≥ 21 mmHg, or (2) condition B: IOP values of ≥ 18 mmHg, with or without topical ocular medication, at two consecutive follow-up visits, or additional operations needed. Risk factors for surgical failure were analyzed via Cox proportional hazards model.
Mean follow-up was 40.0 months (range, 1 to 139 months). Probabilities of treatment success at 1 and 3 years after phaco-GSL were 85.9 % and 85.9 % (condition A) and 66.2 % and 61.0 % (condition B) respectively. Via multivariable analysis, we identified risk factors for surgical failure to be younger age (relative risk [RR] = 0.93/year, P = 0.0333) and absence of postoperative laser peripheral iridoplasty (LPI) (P = 0.0359) for condition A, and younger age (RR = 0.94/year, P = 0.0035), lower preoperative IOP (RR = 0.93/mm Hg, P = 0.0131), and absence of postoperative LPI (RR = 2.34, P = 0.0228) for condition B.
The outcome of phaco-GSL for PAC/PACG may depend on age, preoperative IOP, and postoperative LPI.
评估房角分离术（GSL）联合超声乳化白内障吸除术和人工晶状体植入术（phaco-GSL）治疗原发性闭角型青光眼或原发性闭角型青光眼（PAC/PACG）的长期疗效，并分析手术结果的危险因素。
我们回顾了五家机构的 109 例 109 只眼（平均年龄 70 ± 9.4 岁）接受 phaco-GSL 作为 PAC/PACG 主要治疗的患者的病历。所有患者术前眼压（IOP）均≥21mmHg，无论是否用药。手术失败定义为：（1）条件 A：持续 IOP 值≥21mmHg，或（2）条件 B：IOP 值≥18mmHg，无论是否有局部眼部用药，在两次连续随访时，或需要额外手术。通过 Cox 比例风险模型分析手术失败的危险因素。
平均随访时间为 40.0 个月（范围 1 至 139 个月）。phaco-GSL 治疗后 1 年和 3 年的治疗成功率分别为 85.9%和 85.9%（条件 A）和 66.2%和 61.0%（条件 B）。通过多变量分析，我们发现手术失败的危险因素为年龄较小（相对风险 [RR] = 0.93/年，P = 0.0333）和术后无激光周边虹膜切除术（LPI）（P = 0.0359），对于条件 A，以及年龄较小（RR = 0.94/年，P = 0.0035）、术前 IOP 较低（RR = 0.93/mmHg，P = 0.0131）和术后无 LPI（RR = 2.34，P = 0.0228），对于条件 B。
phaco-GSL 治疗 PAC/PACG 的结果可能取决于年龄、术前 IOP 和术后 LPI。
