经巩膜睫状体光凝术治疗 Trabecctome 术后短期眼压升高：一项回顾性病例系列研究。

Goniopuncture in the treatment of short-term post-Trabectome intraocular pressure elevation: a retrospective case series study.

机构信息

*Faculty of Medicine, McGill University †Department of Ophthalmology, Maisonneuve-Rosemont Hospital, University of Montreal ‡Montreal Glaucoma Institute, Montreal, QC, Canada.

出版信息

J Glaucoma. 2013 Oct-Nov;22(8):e17-20. doi: 10.1097/IJG.0b013e3182595042.

DOI:10.1097/IJG.0b013e3182595042

PMID:22828005

Abstract

PURPOSE

This study characterizes patients with post-Trabectome intraocular pressure (IOP) elevation induced by membrane growth and/or peripheral anterior synechiae and examines the results of Nd:YAG goniopuncture as its treatment.

METHODS

All Trabectome cases received standard postoperative care and no pilocarpine was given. Two groups were identified: (1) Trabectome-goniopuncture (TG) and (2) Trabectome alone (without goniopuncture) (TA). IOP and number of glaucoma medications (NGM) were collected by retrospective review. Information on whether cataract extraction was combined to the Trabectome was also recorded.

RESULTS

In TG group (n=8), pre-Trabectome IOP and NGM were 16.9±3.7 mm Hg and 2.5±1.0, respectively. IOP rose to 21.9±2.9 mm Hg before goniopuncture (P=0.03) but lowered to 16.1±4.8 mm Hg after the treatment (P=0.006). IOP reduction persisted at post-Trabectome 3 months (13.5±1.5 mm Hg), 6.5 months (15.3±9.3 mm Hg), and 10.5 months (13.4±1.0 mm Hg). No significant medication reduction was detected. In TA group (n=22), pre-Trabectome IOP and NGM were 18.1±2.5 mm Hg and 2.7±0.5, respectively. NGM was significantly lowered from post-Trabectome day 1 on (1.8±0.6, P=0.01) and IOP from 3 months on (15.2±1.8 mm Hg, P=0.03). Five (62.5%) TG cases and 18 (81.5%) TA cases underwent combined cataract extraction-Trabectome. Compared with the TA group, TG cases are associated with thinner pachymetry (P=0.034).

CONCLUSIONS

Cleft closure may cause post-Trabectome pressure elevation. Not providing any medication-sparing effect, goniopuncture is, however, effective in lysing these closures and in normalizing the IOP back to its pre-Trabectome level.

摘要

目的

本研究描述了由膜生长和/或周边前粘连引起的 Trabecctome 术后眼压（IOP）升高的患者，并检查了 Nd：YAG 前房角穿刺作为其治疗方法的结果。

方法

所有 Trabecctome 病例均接受标准术后护理，且不给予匹罗卡品。将患者分为两组：（1）Trabectome-前房角穿刺（TG）和（2）单纯 Trabecctome（无前房角穿刺）（TA）。通过回顾性研究收集 IOP 和青光眼药物（NGM）的数量。还记录了是否将白内障摘除与 Trabecctome 联合进行的信息。

结果

在 TG 组（n=8）中，术前 Trabecctome 的 IOP 和 NGM 分别为 16.9±3.7mmHg 和 2.5±1.0。在前房角穿刺前，IOP 升高至 21.9±2.9mmHg（P=0.03），但在治疗后降低至 16.1±4.8mmHg（P=0.006）。Trabectome 术后 3 个月（13.5±1.5mmHg）、6.5 个月（15.3±9.3mmHg）和 10.5 个月（13.4±1.0mmHg）时 IOP 持续下降。未检测到显著的药物减少。在 TA 组（n=22）中，术前 Trabecctome 的 IOP 和 NGM 分别为 18.1±2.5mmHg 和 2.7±0.5。从 Trabecctome 术后第一天起，NGM 显著降低（1.8±0.6，P=0.01），IOP 从 3 个月开始降低（15.2±1.8mmHg，P=0.03）。在 22 例 TA 组患者中，有 5 例（62.5%）和 18 例（81.5%）患者同时接受白内障摘除和 Trabecctome。与 TA 组相比，TG 组的角膜厚度较薄（P=0.034）。