Department of Ophthalmology, Faculty of Medical Science, University of Fukui, Fukui, Japan2Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
JAMA Ophthalmol. 2014 Jan;132(1):69-76. doi: 10.1001/jamaophthalmol.2013.5605.
Whether pseudophakic eyes are resistant to trabeculectomy remains unknown.
To determine the effect of previous phacoemulsification on surgical success of trabeculectomy with mitomycin C for open-angle glaucoma.
DESIGN, SETTING, AND PARTICIPANTS: Prospective clinical cohort study at Kumamoto University Hospital, Kumamoto, Japan, among patients 55 years or older having open-angle glaucoma with intraocular pressure (IOP) of 22 mm Hg or higher, including 39 phakic eyes (phakic group) and 25 pseudophakic eyes after phacoemulsification (pseudophakic group).
Trabeculectomy with mitomycin C was performed.
The primary outcome measure was the probability of success at 1 year after trabeculectomy. Surgical failure was defined as the following 3 IOP levels: 21 mm Hg or higher (criterion A), 18 mm Hg or higher (criterion B), and 15 mm Hg or higher (criterion C). Secondary outcome measures included IOP, the number of postoperative antiglaucoma medications, and the number of laser suture lysis procedures, as well as postoperative complications.
The probabilities of success at 1 year in the phakic vs pseudophakic groups were 95% vs 74% for criterion A (P = .02), 84% vs 62% for criterion B (P = .04), and 67% vs 53% for criterion C (P = .10). Only pseudophakia was significantly associated with outcome in the multivariable analysis for criterion A (relative risk, 9.37) and for criterion B (relative risk, 5.52) (P = .01 for both). Postoperative IOP in the pseudophakic group was significantly higher than that in the phakic group at 6 months (P = .03) and 9 months (P = .047) after trabeculectomy. No significant difference between groups was noted in postoperative complications or in the number of postoperative antiglaucoma medications or the number of laser suture lysis procedures.
Among patients with open-angle glaucoma, trabeculectomy with mitomycin C in pseudophakic eyes after phacoemulsification for target IOP of less than 21 mm Hg or less than 18 mm Hg is less successful compared with that in phakic eyes. No significant difference between phakic and pseudophakic eyes was observed for secondary outcome measures other than IOP.
clinicaltrials.gov Identifier: University Hospital Medical Information Network Clinical Trials Registry of Japan UMIN000001196.
白内障术后的眼睛是否对小梁切除术有抵抗力仍不清楚。
确定超声乳化白内障吸除术后对伴有眼压（IOP）为 22mmHg 或更高的开角型青光眼行丝裂霉素 C 小梁切除术手术成功率的影响。
设计、地点和参与者：在日本熊本大学医院进行的前瞻性临床队列研究，纳入年龄在 55 岁或以上、IOP 为 22mmHg 或更高的开角型青光眼患者，包括 39 只未行白内障手术的眼睛（未手术组）和 25 只行白内障超声乳化术后的眼睛（白内障术后组）。
行丝裂霉素 C 小梁切除术。
主要结局测量指标是小梁切除术后 1 年的成功率。手术失败定义为以下 3 种眼压水平：21mmHg 或更高（标准 A）、18mmHg 或更高（标准 B）和 15mmHg 或更高（标准 C）。次要结局测量指标包括术后眼压、术后抗青光眼药物的数量和激光缝线松解术的数量，以及术后并发症。
未手术组和白内障术后组在标准 A 时的 1 年成功率分别为 95%和 74%（P = .02），在标准 B 时分别为 84%和 62%（P = .04），在标准 C 时分别为 67%和 53%（P = .10）。多变量分析显示，只有白内障术后与标准 A（相对风险，9.37）和标准 B（相对风险，5.52）的结果显著相关（两者 P = .01）。白内障术后组术后 6 个月（P = .03）和 9 个月（P = .047）时的眼压明显高于未手术组。两组间术后并发症、术后抗青光眼药物的数量或激光缝线松解术的数量无显著差异。
在目标 IOP 低于 21mmHg 或低于 18mmHg 的开角型青光眼患者中，超声乳化白内障吸除术后行丝裂霉素 C 小梁切除术，白内障术后眼睛的成功率明显低于未手术眼睛。除眼压外，未手术组和白内障术后组的其他次要结局测量指标无显著差异。
clinicaltrials.gov 标识符：日本大学医院医疗信息网临床试验注册中心 UMIN000001196。
