Panarelli Joseph F, Banitt Michael R, Gedde Steven J, Shi Wei, Schiffman Joyce C, Feuer William J
Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York.
Department of Ophthalmology, University of Washington, Seattle, Washington.
Ophthalmology. 2016 Apr;123(4):789-95. doi: 10.1016/j.ophtha.2015.11.017. Epub 2015 Dec 30.
To compare the safety and efficacy of Baerveldt implantation (Abbott Medical Optics, Santa Ana, CA) and trabeculectomy with mitomycin C (MMC) in patients who have not undergone prior incisional ocular surgery.
Retrospective, comparative case series.
A total of 125 patients with low-risk glaucoma undergoing primary glaucoma surgery, including 55 patients who received a 350-mm(2) Baerveldt glaucoma implant and 70 patients who underwent trabeculectomy with MMC.
Eligible patients were identified using Current Procedural Terminology codes, and their medical records were reviewed retrospectively.
The primary outcome measure was surgical success (intraocular pressure [IOP] ≤21 mmHg and reduced ≥20% from baseline, IOP >5 mmHg, no reoperation for glaucoma, no loss of light-perception vision). Secondary outcome measures included visual acuity, IOP, number of glaucoma medications, and complications.
The cumulative probability of success at 3 years with or without medical therapy was 87% in the Baerveldt group and 76% in the trabeculectomy group (P = 0.23). Postoperative complications occurred in 11 patients (20%) in the Baerveldt group and 20 patients (29%) in the trabeculectomy group (P = 0.27). Mean follow-up ± standard deviation was 27±19 months in the Baerveldt group and 34±20 months in the trabeculectomy group (P = 0.053).
Similar rates of surgical success and postoperative complications were observed in patients undergoing trabeculectomy with MMC and in those undergoing Baerveldt implantation during 3 years of follow-up. Both are viable primary glaucoma procedures in patients who have not undergone prior ocular surgery.
比较在未接受过眼部切开手术的患者中，Baerveldt植入术（雅培医疗光学公司，加利福尼亚州圣安娜）与丝裂霉素C（MMC）小梁切除术的安全性和有效性。
回顾性、比较性病例系列研究。
共有125例低风险青光眼患者接受原发性青光眼手术，其中55例接受350平方毫米的Baerveldt青光眼植入物，70例接受MMC小梁切除术。
使用当前手术操作术语代码识别符合条件的患者，并对其病历进行回顾性审查。
主要观察指标为手术成功（眼压[IOP]≤21 mmHg且较基线降低≥20%，IOP>5 mmHg，无青光眼再次手术，无光感视力丧失）。次要观察指标包括视力、IOP、青光眼药物使用数量和并发症。
无论是否接受药物治疗，Baerveldt组3年时的累积成功概率为87%，小梁切除术组为76%（P = 0.23）。Baerveldt组11例患者（20%）发生术后并发症，小梁切除术组20例患者（29%）发生术后并发症（P = 0.27）。Baerveldt组的平均随访时间±标准差为27±19个月，小梁切除术组为34±20个月（P = 0.053）。
在3年的随访中，接受MMC小梁切除术的患者和接受Baerveldt植入术的患者手术成功率和术后并发症发生率相似。对于未接受过眼部手术的患者，这两种手术都是可行的原发性青光眼手术方式。
