原发性开角型青光眼小梁切除术联合5-氟尿嘧啶与Ologen植入物的疗效比较

Shihadeh Wisam, Massad Ihab, Khader Yousef, Al-Rawi Ahmed, Alshalakhti Tala

Jordan University of Science and Technology, Irbid, Jordan.

Ophthalmic Res. 2017;58(2):94-98. doi: 10.1159/000471883. Epub 2017 May 4.

PURPOSE

To compare the outcomes of trabeculectomy with 5-fluorouracil (5-FU) versus Ologen™ implant in patients with primary open-angle glaucoma.

METHODS

A retrospective chart review was performed of patients with primary open-angle glaucoma who underwent trabeculectomy using either Ologen or 5-FU over 12 consecutive months. The patients had moderate-to-advanced primary open-angle glaucoma and uncontrolled intraocular pressure (IOP) on maximally tolerated medical treatment. Fornix-based trabeculectomy was performed on all patients by the same surgeon. The outcomes that were recorded and analyzed included the IOP level and number of glaucoma medications before and after surgery as well as the complications. All patients were followed for at least 3 months.

RESULTS

A total of 58 eyes (of 47 patients) were included in this study. The eyes were divided into 2 groups: the 5-FU group (n = 30, 51.7%) and the Ologen group (n = 28, 48.3%). The demographics and preoperative clinical features were not significantly different between the 2 groups. Repeated-measures analysis showed a significant decrease in IOP after trabeculectomy in both groups, with a marked decrease at day 1 after surgery. The amount of relative change at postoperative day 1 was significantly higher in the Ologen group (62.1 vs. 45.2%; p = 0.025). After this, there were no significant changes over time in IOP measurements in either group. In all the eyes, there was a significant drop in the number of antiglaucoma medications used after the surgery (p < 0.005), i.e. from 4.0 to 1.4 and from 4.3 to 1.0 in the 5-FU and Ologen groups, respectively, with no significant differences between groups (p = 0.303). Complications were few and minor in both groups. Bleb revision was needed in 2 eyes in the 5-FU group and in 4 eyes in the Ologen group.

CONCLUSION

The efficacy and safety of trabeculectomy with 5-FU was similar to that with Ologen. Further studies with a larger number of patients and longer follow-up periods are needed.

目的

比较原发性开角型青光眼患者小梁切除术联合5-氟尿嘧啶（5-FU）与Ologen™植入物的治疗效果。

方法

对连续12个月内接受Ologen或5-FU小梁切除术的原发性开角型青光眼患者进行回顾性病历审查。这些患者患有中度至重度原发性开角型青光眼，且在最大耐受药物治疗下眼压控制不佳。所有患者均由同一位外科医生进行以穹窿为基底的小梁切除术。记录并分析的结果包括手术前后的眼压水平、青光眼药物使用数量以及并发症情况。所有患者均随访至少3个月。

结果

本研究共纳入47例患者的58只眼，并将其分为两组：5-FU组（n = 30，51.7%）和Ologen组（n = 28，48.3%）。两组患者的人口统计学特征和术前临床特征无显著差异。重复测量分析显示，两组小梁切除术后眼压均显著降低，术后第1天眼压明显下降。Ologen组术后第1天的相对变化量显著更高（62.1%对45.2%；p = 0.025）。此后，两组眼压测量值随时间均无显著变化。所有眼中，术后抗青光眼药物使用数量均显著下降（p < 0.005），即5-FU组从4.0降至1.4，Ologen组从4.3降至1.0，两组间无显著差异（p = 0.303）。两组并发症均较少且轻微。5-FU组有2只眼需要进行滤过泡修补，Ologen组有4只眼需要进行滤过泡修补。