Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan.
Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan.
Am J Ophthalmol. 2018 Mar;187:43-50. doi: 10.1016/j.ajo.2017.12.012. Epub 2017 Dec 26.
To compare changes in the macular ganglion cell layer and inner plexiform layer (mGCIPL) thickness over 5 years between surgically treated eyes (STE) and medically treated eyes (MTE) with advanced glaucoma.
Retrospective, comparative case series.
Eighty-six patients comprising 43 with open-angle glaucoma (OAG) with trabeculectomy and 43 with medically treated OAG. The mGCIPL thickness was measured more than 5 times during follow-up by optical coherence tomography. Main outcome measure was differences in mGCIPL thickness thinning rate between the groups.
The mean age at study initiation was 62.5 ± 9.2 years in STE and 62.7 ± 9.5 years in MTE. The mean deviations (MD), according to the Humphrey Field Analyzer central program 30-2, and the mGCIPL thickness in each sector showed no significant differences at initial measurement. The averaged intraocular pressure (IOP) throughout follow-up was 10.5 ± 2.0 mm Hg in STE and 10.8 ± 0.8 mm Hg in MTE (P = .429; Mann-Whitney U test). There was no significant difference in the MD changes over 5 years between the 2 groups (P = .405; Mann-Whitney U test). Changes in the mGCIPL thickness over 5 years in MTE were significantly greater than that in STE in all sectors (all 6 sectors P < .0001, Mann-Whitney U test). The IOP fluctuation over 5 years in STE was significantly less than that in MTE (P < .0001, Mann-Whitney U test).
The structure of the mGCIPL was better preserved in STE than in MTE, even when the IOPs during follow-up were similar.
比较手术治疗眼（STE）和药物治疗眼（MTE）治疗晚期青光眼后 5 年内黄斑神经节细胞层和内丛状层（mGCIPL）厚度的变化。
回顾性、比较病例系列。
86 例患者，其中 43 例为开角型青光眼（OAG）伴小梁切除术，43 例为药物治疗的 OAG。在随访期间，通过光学相干断层扫描（OCT）多次测量 mGCIPL 厚度。主要观察指标为两组间 mGCIPL 厚度变薄率的差异。
STE 组和 MTE 组患者研究开始时的平均年龄分别为 62.5±9.2 岁和 62.7±9.5 岁。根据 Humphrey 视野分析仪中央程序 30-2，在初始测量时，各组的平均偏差（MD）和 mGCIPL 厚度无显著差异。STE 组和 MTE 组患者的平均眼压（IOP）在整个随访期间分别为 10.5±2.0mmHg 和 10.8±0.8mmHg（P=0.429；Mann-Whitney U 检验）。两组患者 5 年内 MD 变化无显著差异（P=0.405；Mann-Whitney U 检验）。与 STE 组相比，MTE 组 5 年内 mGCIPL 厚度的变化在所有象限均显著增大（所有 6 个象限 P<0.0001，Mann-Whitney U 检验）。STE 组眼压波动较 MTE 组显著减少（P<0.0001，Mann-Whitney U 检验）。
即使在随访期间的 IOP 相似的情况下，STE 组的 mGCIPL 结构也比 MTE 组保存得更好。
