小梁微旁路分流器植入术治疗复合机制闭角型青光眼患者的疗效。
Efficacy of Cataract Surgery With Trabecular Microbypass Stent Implantation in Combined-Mechanism Angle Closure Glaucoma Patients.
机构信息
Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA; Glaucoma Research Unit, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA.
出版信息
Am J Ophthalmol. 2018 Nov;195:191-198. doi: 10.1016/j.ajo.2018.08.003. Epub 2018 Aug 8.
PURPOSE
To evaluate the effectiveness of trabecular microbypass stent (iStent) implantation in combined mechanism glaucoma (CMG).
DESIGN
Retrospective cohort study.
METHODS
We reviewed the medical charts of patients with the following scenarios: (1) primary open-angle glaucoma (POAG) undergoing phacoemulsification (PE), (2) POAG undergoing PE with iStent (POAG-PE/iStent), (3) CMG undergoing PE (CMG-PE), and (4) CMG undergoing PE with iStent (CMG-PE/iStent). CMG was defined as narrow-angle glaucoma patients whose angle had opened after iridotomy. Linear mixed-effects models were performed to determine the effect of iStent on postoperative 1-year success rate (intraocular pressure [IOP] ≤ 18 without medication), IOP, and number of medications.
RESULTS
Data from 301 eyes were available. The number of eyes (subjects) was 61 (45) in the POAG-PE, 60 (50) in POAG-PE/iStent, 93 (76) in CMG-PE, and 87 (70) in CMG-PE/iStent group. Success criteria were achieved in 13.1% for POAG-PE, 33.3% for POAG-PE/iStent (POAG-PE vs POAG-PE/iStent B 3.01; P < .001), 37.6% for CMG-PE, and 43.7% for CMG-PE/iStent (CMG-PE vs CMG-PE/iStent B 2.25; P < .001). There was no difference in the IOP between POAG-PE and POAG-PE/iStent, and between CMG-PE and CMG-PE/iStent. The iStent significantly reduced number of medications in the POAG (B -0.70; P < .001) and CMG group (B -0.52; P < .001). Comparing the effect of iStent on POAG and CMG, the analysis showed similar iStent efficacy in terms of the success rate, IOP, and number of medications (P > .05).
CONCLUSIONS
Combined PE/iStent significantly increased success rate and reduced number of medications in CMG patients compared to PE alone. The effects of iStent were comparable between POAG and CMG groups.
目的
评估小梁微旁路支架（iStent）植入治疗复合机制青光眼（CMG）的效果。
设计
回顾性队列研究。
方法
我们回顾了以下情况下患者的病历：（1）行超声乳化白内障吸除术（PE）的原发性开角型青光眼（POAG），（2）行 PE 联合 iStent（POAG-PE/iStent）的 POAG，（3）行 PE 的 CMG，以及（4）行 PE 联合 iStent（CMG-PE/iStent）的 CMG。CMG 的定义为房角切开术后房角已开放的窄角青光眼患者。采用线性混合效应模型来确定 iStent 对术后 1 年成功率（无药物治疗时眼压 [IOP]≤18mmHg）、IOP 和药物使用数量的影响。
结果
共纳入 301 只眼的数据。POAG-PE 组、POAG-PE/iStent 组、CMG-PE 组和 CMG-PE/iStent 组的眼数（受试者）分别为 61（45）、60（50）、93（76）和 87（70）。POAG-PE 组成功率为 13.1%，POAG-PE/iStent 组为 33.3%（POAG-PE 与 POAG-PE/iStent 相比 B 3.01；P<.001），CMG-PE 组为 37.6%，CMG-PE/iStent 组为 43.7%（CMG-PE 与 CMG-PE/iStent 相比 B 2.25；P<.001）。POAG-PE 组和 POAG-PE/iStent 组、CMG-PE 组和 CMG-PE/iStent 组的 IOP 无差异。iStent 可显著减少 POAG（B-0.70；P<.001）和 CMG 组（B-0.52；P<.001）的药物使用数量。比较 iStent 对 POAG 和 CMG 的效果，分析表明 iStent 在成功率、IOP 和药物使用数量方面对 POAG 和 CMG 的效果相似（P>.05）。
结论
与单独行 PE 相比，联合行 PE/iStent 可显著提高 CMG 患者的成功率并减少药物使用数量。iStent 在 POAG 组和 CMG 组中的效果相当。
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