Murray Desirée, Shah Peter
Department of Clinical Surgical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago, West Indies,
Birmingham Institute for Glaucoma Research, Institute of Translational Medicine, Birmingham, UK,
Clin Ophthalmol. 2018 Sep 11;12:1775-1784. doi: 10.2147/OPTH.S165544. eCollection 2018.
The objective of the study was to present evidence of successful skills transfer of the Moorfields Safer Surgery System (MSSS) from the UK to Trinidad and Tobago and the safety and efficacy of this technique.
Hospital-based retrospective, consecutive, non-comparative case series study of 33 eyes (24 African-Caribbean patients; 16 male patients) with primary open-angle glaucoma undergoing trabeculectomy + mitomycin C (MSSS) by a single surgeon with UK Glaucoma Fellowship training. The clinical outcome measures included intraocular pressure (IOP), bleb morphology, postsurgical interventions, postoperative complications, and best-corrected visual acuity (BCVA) at the final follow-up.
All patients were self-identified as African-Caribbean. The median age was 56 years (range 34-79 years). The mean preoperative IOP on maximum tolerated medical treatment was 22.4 mmHg (SD=5.9 mmHg). With or without medication, IOP was ≤21 mmHg in 92.6% at 1 year and 87.5% at 5 years. At 1 year, IOP was ≤18 mmHg in 78%, ≤15 mmHg in 73% and ≤14 mmHg in 52%. Removal of scleral flap releasable suture(s) was performed in 84%, 5-fluorouracil injection(s) in 88% and bleb needling revision in 38%. The most common complication was early transient bleb leak (52%). No patient developed endophthalmitis, hypotony maculopathy, suprachoroidal hemorrhage, or malignant glaucoma. At the final follow-up, 91% had excellent or satisfactory bleb morphology, and 73% had equal or better BCVA.
Skills transfer between different geographical and economic regions contributes to the prevention of avoidable blindness through disease control - one of the core strategies of the World Health Organization's Vision 2020 initiative. In the Caribbean (Trinidad and Tobago), the MSSS was utilized by a surgeon with Glaucoma Fellowship training and achieved outcomes similar to best-published data. This success can be reproduced in other geographic locations.
本研究的目的是提供证据，证明莫菲尔德更安全手术系统（MSSS）从英国成功转移至特立尼达和多巴哥，以及该技术的安全性和有效性。
基于医院的回顾性、连续性、非对照病例系列研究，纳入33只眼（24例非洲加勒比裔患者；16例男性患者），均为原发性开角型青光眼，由一名接受过英国青光眼专科培训的外科医生进行小梁切除术+丝裂霉素C（MSSS）。临床结局指标包括眼压（IOP）、滤过泡形态、术后干预、术后并发症以及最后一次随访时的最佳矫正视力（BCVA）。
所有患者均自认为是非洲加勒比裔。中位年龄为56岁（范围34 - 79岁）。最大耐受药物治疗下的术前平均眼压为22.4 mmHg（标准差=5.9 mmHg）。无论是否用药，1年时眼压≤21 mmHg的患者占92.6%，5年时占87.5%。1年时，眼压≤18 mmHg的患者占78%，≤15 mmHg的患者占73%，≤14 mmHg的患者占52%。84%的患者进行了巩膜瓣可松解缝线拆除，88%的患者进行了5-氟尿嘧啶注射，38%的患者进行了滤过泡针刺修复。最常见的并发症是早期短暂性滤过泡渗漏（52%）。无患者发生眼内炎、低眼压性黄斑病变、脉络膜上腔出血或恶性青光眼。在最后一次随访时，91%的患者滤过泡形态良好或满意，73%的患者BCVA相等或更好。
不同地理和经济区域之间的技术转移有助于通过疾病控制预防可避免的失明，这是世界卫生组织“视觉2020”倡议的核心战略之一。在加勒比地区（特立尼达和多巴哥），一名接受过青光眼专科培训的外科医生采用了MSSS，取得了与已发表的最佳数据相似的结果。这一成功可在其他地理位置复制。
