Leleu Igor, Penaud Benjamin, Blumen-Ohana Esther, Rodallec Thibault, Adam Raphaël, Laplace Olivier, Akesbi Jad, Nordmann Jean-Philippe
Centre Hospitalier National d'Ophtalmologie des XV-XX, Service du Pr. NORDMANN, 28 rue de Charenton, 75012, Paris, France.
Graefes Arch Clin Exp Ophthalmol. 2018 Aug;256(8):1489-1498. doi: 10.1007/s00417-018-4025-6. Epub 2018 Jun 3.
To report the impact of non-penetrating deep sclerectomy (NPDS) in severe and end-stage glaucoma treatment on the central 10° visual field progression (mean deviation, four central points, foveal threshold) and assess the risk of sudden visual loss.
Monocenter database study. We reviewed records of 34 eyes with severe or end-stage glaucoma that underwent NPDS between 2009 and 2015, at the National Ophthalmology Center of XV-XX (Paris, France). Severe and end-stage glaucoma were defined according to the Bascom Palmer Modified Glaucoma Staging System classification. All eyes had a constricted visual field < 10° (severe injury by the Humphrey visual field automated (HVFA) 10-2). Visual fields were recorded every 6 months after the procedure. Data from the last visit was used for the statistical analysis.
The mean follow-up duration was 29 months (range 6 to 54) and 33 (97%) eyes were followed for more than 1 year. There were no cases of postoperative sudden visual loss. The intraocular pressure (IOP) decreased from 21.9 ± 8.1 to 15.0 ± 5.4 mmHg (P < .001). Twenty-eight (82%) eyes had an IOP < 21 mmHg and 19 (56%) an IOP < 16 mmHg. The MD 10-2 remained stable (- 19.8 ± 7.4 to - 19.4 ± 8.1 dB, non-significant improvement of + 0.4 dB, P = .1). The MD 10-2 slope showed an insignificant improvement of + 0.25 ± 1.8 dB per year (dB/y) (P = 0.1), but this slope was significantly better when the IOP was reduced to < 16 mmHg than when the IOP was ≥ 16 mmHg at the last visit (+ 0.84 1.2 versus - 0.48 ± 2.2 dB/y, P = .05). The mean number of the four central test points with sensitivity ≤ 5 dB and the change in mean sensitivity of the four central field points remained stable. There were no significant changes in the VFI (from 25.4% ± 13 to 25.8% ± 20) and in foveal threshold.
NPDS appears to provide stability of the central 10° visual field (with a trend towards improvement but non-significant) with no occurrence of "wipe-out" phenomenon and few other complications. Consideration of NPDS in end-stage and severe glaucoma is advisable given its low risk of complications and its considerable IOP decrease with a relative stability of the central visual field.
报告非穿透性深层巩膜切除术（NPDS）治疗重度和终末期青光眼对中央10°视野进展（平均偏差、四个中心点、黄斑阈值）的影响，并评估突然视力丧失的风险。
单中心数据库研究。我们回顾了2009年至2015年间在法国巴黎XV-XX国家眼科中心接受NPDS的34只重度或终末期青光眼患者的记录。重度和终末期青光眼根据巴斯科姆帕尔默改良青光眼分期系统分类进行定义。所有眼睛的视野均受限<10°（经汉弗莱视野自动分析仪（HVFA）10-2检测为重度损伤）。术后每6个月记录一次视野。将最后一次就诊的数据用于统计分析。
平均随访时间为29个月（范围6至54个月），33只（97%）眼睛随访时间超过1年。无术后突然视力丧失病例。眼压从21.9±8.1 mmHg降至15.0±5.4 mmHg（P<0.001）。28只（82%）眼睛的眼压<21 mmHg，19只（56%）眼睛的眼压<16 mmHg。10-2平均偏差保持稳定（从-19.8±7.4 dB降至-19.4±8.1 dB，改善不显著，仅提高了0.4 dB，P = 0.1）。10-2平均偏差斜率每年改善不显著，为+0.25±1.8 dB/年（dB/y）（P = 0.1），但在最后一次就诊时，当眼压降至<16 mmHg时，该斜率显著优于眼压≥16 mmHg时（分别为+0.84±1.2 dB/y和-0.48±2.2 dB/y，P = 0.05）。四个中央测试点敏感度≤5 dB的平均数量以及四个中央视野点平均敏感度的变化保持稳定。视野指数（VFI）（从25.4%±13降至25.8%±20）和黄斑阈值无显著变化。
NPDS似乎能使中央10°视野保持稳定（有改善趋势但不显著），未出现“视野消失”现象，其他并发症也较少。鉴于其并发症风险低、眼压显著降低且中央视野相对稳定，对于终末期和重度青光眼，考虑采用NPDS是可取的。
