Iwasaki Kentaro, Takamura Yoshihiro, Nishida Takashi, Sawada Akira, Iwao Keiichiro, Shinmura Ayano, Kunimatsu-Sanuki Shiho, Yamamoto Tetsuya, Tanihara Hidenobu, Sugiyama Kazuhisa, Nakazawa Toru, Inatani Masaru
Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan.
PLoS One. 2016 Sep 13;11(9):e0162569. doi: 10.1371/journal.pone.0162569. eCollection 2016.
To compare surgical outcomes between the first and second operated eyes in patients who underwent trabeculectomy in both eyes.
This retrospective clinical cohort study at five clinical centers in Japan included 84 patients with open-angle glaucoma who underwent primary trabeculectomy in both eyes. The primary outcome was surgical success or failure, with failure being defined according to three criteria: <20% reduction of the preoperative intraocular pressure (IOP), or Criterion A, IOP >21 mmHg; Criterion B, IOP >18 mmHg; or Criterion C, IOP >15 mmHg. Cases of reoperation, a loss of light perception vision, or hypotony were also considered as "failures".
There were no significant differences in success rate for any of the three criteria between the first and second operated eyes. For patients whose first trabeculectomy was successful, when the second trabeculectomy was performed ≥2 months after the first, the survival curves for all three criteria for the second trabeculectomy were significantly worse than those for patients waiting a shorter interval between trabeculectomies (Criterion A, 52.0% vs 83.6%, P = 0.0031; Criterion B, 51.5% vs 80.4%, P = 0.026; Criterion C, 51.1% vs 80.4%, P = 0.048). In multivariable analyses, a longer interval between trabeculectomies was a significant prognostic factor for surgical failure (Criterion A, P = 0.0055; Criterion B, P = 0.0023; Criterion C, P = 0.027). However, no dependency on the interval between trabeculectomies was found among patients whose first trabeculectomy failed.
If the first trabeculectomy is successful, a long interval before the second trabeculectomy increases the risk of surgical failure in the second eye. This result has clinical implications for developing surgical strategies for patients with bilateral glaucoma.
比较双眼接受小梁切除术患者的首次手术眼和二次手术眼的手术效果。
这项在日本五个临床中心开展的回顾性临床队列研究纳入了84例双眼接受原发性小梁切除术的开角型青光眼患者。主要结局为手术成功或失败，失败根据以下三个标准定义：术前眼压（IOP）降低<20%，即标准A，IOP>21 mmHg；标准B，IOP>18 mmHg；或标准C，IOP>15 mmHg。再次手术、光感丧失或低眼压病例也被视为“失败”。
首次手术眼和二次手术眼在任何一个标准下的成功率均无显著差异。对于首次小梁切除术成功的患者，当二次小梁切除术在首次术后≥2个月进行时，二次小梁切除术所有三个标准的生存曲线均显著差于小梁切除术间隔时间较短的患者（标准A，52.0%对83.6%，P = 0.0031；标准B，51.5%对80.4%，P = 0.026；标准C，51.1%对80.4%，P = 0.048）。在多变量分析中，小梁切除术间隔时间较长是手术失败的显著预后因素（标准A，P = 0.0055；标准B，P = 0.0023；标准C，P = 0.027）。然而，在首次小梁切除术失败的患者中未发现对小梁切除术间隔时间的依赖性。
如果首次小梁切除术成功，二次小梁切除术之前的间隔时间过长会增加第二只眼手术失败的风险。这一结果对制定双侧青光眼患者的手术策略具有临床意义。
