Skalicky Simon E, Lew Henry R
*Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
J Glaucoma. 2015 Jan;24(1):37-44. doi: 10.1097/IJG.0b013e3182883c44.
To determine the performance of combined trabeculectomy-cyclodialysis surgery over a 25-year period.
A retrospective cohort study of 55 eyes (39 patients) treated between 1987 and 2012 was performed.The following data were collected: age, sex, glaucoma etiology, preoperative and postoperative number of topical medications, preoperative and postoperative laser trabeculoplasty, intraoperative and postoperative 5-fluorouracil application, lens status at the time of surgery, postoperative cataract surgery, duration of follow-up, and complications. Best-corrected LogMAR visual acuity was assessed preoperatively, at 1 year, and then at 2-yearly intervals for the duration of follow-up. Intraocular pressure (IOP) was assessed preoperatively and then at 1 week, 4 weeks, 1 year, and then at 2-yearly intervals for the duration of follow-up. Visual field indices were collected at baseline and at the completion of follow-up.Failure was defined as reoperation for glaucoma, progression to legal blindness, IOP≤5 mm Hg, >21 mm Hg, or <20% reduction below baseline. All others were a "complete success" if no additional topical medication was required and a "qualified success" if medication was required. Analyses using 18 and 15 mm Hg as upper limits for success were also performed.
Mean IOP fell from 25.2 to 11.9 mm Hg over a mean 11.2 years. At completion of follow-up 32 eyes (58.2%) achieved an unqualified success, 18 (32.7%) a qualified success, and 5 (9.1%) a failure. No patient progressed to legal blindness. Cases with greater preoperative IOP had a greater reduction in IOP (P<0.0001). On univariate analysis no intraoperative application of antimetabolite (OR, 0.74; 95% CI, 0.49-0.94; P=0.022) and a longer follow-up (OR, 1.16; 95% CI, 1.02-1.33; P=0.025) predicted a higher final IOP; these were not significant on multivariate analysis. Thirty-six of 47 phakic eyes developed cataract; the majority occurred in the first 4 years.
Combined trabeculectomy-cyclodialysis produces sustained lowering of IOP for long periods of time, despite a cataractogenic effect.
确定小梁切除术-睫状体分离术联合手术在25年期间的疗效。
对1987年至2012年期间接受治疗的55只眼（39例患者）进行回顾性队列研究。收集以下数据：年龄、性别、青光眼病因、术前和术后局部用药数量、术前和术后激光小梁成形术、术中及术后5-氟尿嘧啶应用、手术时晶状体状态、术后白内障手术、随访时间及并发症。在术前、术后1年以及随后随访期间每2年评估一次最佳矫正LogMAR视力。术前及术后1周、4周、1年以及随后随访期间每2年评估一次眼压（IOP）。在基线和随访结束时收集视野指数。失败定义为因青光眼再次手术、进展为法定盲、IOP≤5 mmHg、>21 mmHg或较基线降低<20%。如果无需额外局部用药，则所有其他情况为“完全成功”；如果需要用药，则为“合格成功”。还进行了以18 mmHg和15 mmHg作为成功上限的分析。
在平均11.2年的时间里，平均IOP从25.2 mmHg降至11.9 mmHg。随访结束时，32只眼（58.2%）取得了不合格成功，18只眼（32.7%）取得了合格成功，5只眼（9.1%）失败。没有患者进展为法定盲。术前IOP较高的病例IOP降低幅度更大（P<0.0001）。单因素分析显示，术中未应用抗代谢药物（OR，0.74；95%CI，0.49-0.94；P=0.022）和随访时间较长（OR，1.16；95%CI，1.02-1.33；P=0.025）预测最终IOP较高；多因素分析时这些因素无统计学意义。47只晶状体眼中有36只发生了白内障；大多数发生在前4年。
小梁切除术-睫状体分离术联合手术可使IOP长期持续降低，尽管有致白内障作用。
