Shoji Nobuyuki, Kasahara Masayuki, Iijima Ayaka, Takahashi Masahide, Tatsui Sonoko, Matsumura Kazuhiro, Morita Tetsuya, Shimizu Kimiya
Department of Rehabilitation, Orthoptics and Visual Science Course, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.
Department of Ophthalmology, School of Medicine, Kitasato University, Sagamihara, Japan.
Jpn J Ophthalmol. 2016 May;60(3):156-65. doi: 10.1007/s10384-016-0433-5. Epub 2016 Feb 29.
To evaluate the short-term results of Trabectome surgery performed on Japanese patients.
Retrospective observational study. Trabectome surgery was performed on 117 eyes from 101 patients at Kitasato University Hospital from December 2010 to June 2013, involving 48 eyes with primary open-angle glaucoma (POAG), 62 eyes with secondary open-angle glaucoma (SOAG), and 7 eyes with developmental glaucoma. Trabectome surgery alone was performed on 34 phakic eyes (the phakic group) and 35 pseudophakic eyes (the pseudophakic group), and Trabectome surgery combined with phacoemulsification (the combined surgery group) was performed on 48 eyes. The main outcomes assessed were intraocular pressure (IOP), number of IOP-lowering medications, and success probabilities using Kaplan-Meier life-table analyses. Failure risk factors were identified using the Cox proportional hazards ratio.
In all cases, after a mean follow-up of 18.5 ± 13.5 months, IOP was reduced from 31.6 ± 9.9 (SD) mmHg using 5.0 ± 1.7 medications to 16.4 ± 5.4 mmHg using 3.8 ± 1.8 medications. One year after surgery, IOP was reduced from 29.4 ± 7.8 to 16.1 ± 3.8 mmHg in POAG, from 33.6 ± 11.1 to 14.7 ± 2.9 mmHg in SOAG, from 33.0 ± 10.2 to 15.7 ± 3.3 mmHg in the phakic group, from 32.6 ± 9.3 to 15.3 ± 3.0 mmHg in the pseudophakic group, and from 29.9 ± 10.0 to 15.2 ± 3.0 mmHg in the combined surgery group. There were no statistically significant differences in IOP at each measurement point, either between POAG and SOAG or among the three procedure subtypes. The POAG and SOAG success rates at 12 months using postoperative IOP ≤ 21 mmHg and ≥20 % reduction in baseline as criteria were 53.9 and 77.2 %, respectively (p = 0.024, log-rank test). Twenty-one eyes (17.9 %) needed additional trabeculectomy. None of the univariate and multivariate risk factors for failure were detected.
Trabectome surgery is safe and effective for Japanese patients whose target IOP is 18 mmHg or above. However, it is necessary to carefully consider Trabectome surgery for advanced POAG cases.
评估对日本患者施行 Trabectome 手术的短期效果。
回顾性观察研究。2010 年 12 月至 2013 年 6 月期间，在北里大学医院对 101 例患者的 117 只眼睛施行 Trabectome 手术，其中包括 48 只原发性开角型青光眼（POAG）眼睛、62 只继发性开角型青光眼（SOAG）眼睛和 7 只发育性青光眼眼睛。对 34 只晶状体眼（晶状体眼组）和 35 只人工晶状体眼（人工晶状体眼组）单独施行 Trabectome 手术，对 48 只眼睛施行 Trabectome 手术联合超声乳化术（联合手术组）。评估的主要指标为眼压（IOP）、降低眼压药物的数量，以及使用 Kaplan-Meier 生存表分析的成功概率。使用 Cox 比例风险比确定失败风险因素。
所有病例平均随访 18.5±13.5 个月后，眼压从使用 5.0±1.7 种药物时的 31.6±9.9（标准差）mmHg 降至使用 3.8±1.8 种药物时的 16.4±5.4 mmHg。术后 1 年，POAG 患者的眼压从 29.4±7.8 降至 16.1±3.8 mmHg，SOAG 患者从 33.6±11.1 降至 14.7±2.9 mmHg，晶状体眼组从 33.0±10.2 降至 15.7±3.3 mmHg，人工晶状体眼组从 32.6±9.3 降至 15.3±3.0 mmHg，联合手术组从 29.9±10.0 降至 15.2±3.0 mmHg。在每个测量点，POAG 与 SOAG 之间或三种手术亚型之间的眼压均无统计学显著差异。以术后眼压≤21 mmHg 且较基线降低≥20%为标准，POAG 和 SOAG 在 12 个月时的成功率分别为 53.9%和 77.2%（p = 0.024，对数秩检验）。21 只眼睛（17.9%）需要额外施行小梁切除术。未检测到失败的单因素和多因素风险因素。
对于目标眼压为 18 mmHg 或更高的日本患者，Trabectome 手术安全有效。然而，对于晚期 POAG 病例，有必要仔细考虑 Trabectome 手术。
