Matlach Juliane, Hipp Matthias, Wagner Martin, Heuschmann Peter U, Klink Thomas, Grehn Franz
Department of Ophthalmology, University of Würzburg, Würzburg, Germany.
Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany ; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.
Clin Ophthalmol. 2015 Mar 13;9:483-92. doi: 10.2147/OPTH.S74853. eCollection 2015.
The objective of the study reported here was to evaluate the outcome of a modified filtering trabeculotomy (FTO) without iridectomy in open-angle glaucoma compared with that of conventional trabeculectomy (trab).
Thirty eyes of 30 patients who underwent modified FTO were prospectively followed for 1 year and were compared with 87 conventional trab patients (87 eyes), matched for age and preoperative intraocular pressure (IOP). The FTO procedure consisted of a deep sclerectomy and trabeculotomy preserving the trabeculo-Descemet membrane, without iridectomy. Main outcome measures were complete success (IOP <18 mmHg and >/=30% IOP reduction, without medication), IOP, visual acuity, medication, complications, and subsequent surgeries.
In the conventional trab group, the median preoperative IOP was 23.0 mmHg (interquartile range 20.0-27.0) with 3.0 (2.0-3.0) medications, compared with 23.0 mmHg (20.0-27.0) and 3.0 (2.8-4.0) in the modified FTO group. Median postoperative IOP at 12 months was 12.0 mmHg (10.0-13.0) in the conventional trab and 11.0 mmHg (8.0-14.0) in the modified FTO group (P=0.3). The complete success rate at 1 year was 83.1% and 79.3% in the conventional trab group and modified FTO group, respectively (P=0.8). The complications hypotony (20.7%, 24.1%), choroidal detachment (2.3%, 10.3%), and bleb scarring (17.2%, 13.8%), were present in the conventional trab group and modified FTO group, respectively.
The outcomes of reduced IOP and medications in the FTO group were not different to those in the conventional trab group over 1 year, but some complications were more often seen with the modified FTO technique. The new filtration trabeculotomy, however, has the advantage of avoiding iridectomy, thus reducing the risk of cataract formation, and may result in the development of more favorable blebs by controlling the flow over two resistance levels.
本研究报告的目的是评估改良小梁切开滤过术（FTO）在开角型青光眼患者中不联合虹膜切除术的效果，并与传统小梁切除术（trab）进行比较。
对30例行改良FTO的患者的30只眼进行前瞻性随访1年，并与87例传统小梁切除术患者（87只眼）进行比较，两组患者年龄和术前眼压（IOP）相匹配。FTO手术包括深层巩膜切除术和小梁切开术，保留小梁-Descemet膜，不进行虹膜切除术。主要观察指标包括完全成功（眼压<18 mmHg且眼压降低≥30%，无需药物治疗）、眼压、视力、用药情况、并发症及后续手术。
在传统小梁切除术组中，术前眼压中位数为23.0 mmHg（四分位间距20.0 - 27.0），用药3.0（2.0 - 3.0）种；改良FTO组分别为23.0 mmHg（20.0 - 27.0）和3.0（2.8 - 4.0）种。传统小梁切除术组术后12个月眼压中位数为12.0 mmHg（10.0 - 13.0），改良FTO组为11.0 mmHg（8.0 - 14.0）（P = 0.3）。传统小梁切除术组和改良FTO组1年时的完全成功率分别为83.1%和79.3%（P = 0.8）。传统小梁切除术组和改良FTO组分别出现低眼压（20.7%，24.1%）、脉络膜脱离（2.3%，10.3%）和滤过泡瘢痕形成（17.2%，13.8%）等并发症。
改良FTO组眼压降低和用药情况在1年时与传统小梁切除术组无差异，但改良FTO技术某些并发症更常见。然而，新的小梁切开滤过术具有避免虹膜切除术的优点，从而降低了白内障形成的风险，并且通过控制两个阻力水平的房水引流可能会形成更有利的滤过泡。
