深巩膜切除术（Deep Sclerectomy）后的白内障（Cataract）提取及其对眼压控制的影响。
Cataract extraction after deep sclerectomy and its effect on intraocular pressure control.
机构信息
Manchester University Hospitals NHS Trust, Manchester, UK.
University Hospital Bristol NHS Trust, Bristol, UK.
出版信息
Eye (Lond). 2019 Apr;33(4):557-563. doi: 10.1038/s41433-018-0262-5. Epub 2018 Oct 31.
PURPOSE
To estimate the incidence and predisposing factors for cataract extraction (CE) after Deep Sclerectomy (DS) with Mitomycin-C (MMC) and its effect on intraocular pressure (IOP) control.
METHODS
Retrospective study of phakic eyes which had DS with MMC performed over a 5-year period. 179 eyes of 179 patients were included.
RESULTS
Mean age at time of DS was 68.6 ± 9.7 years and mean follow-up was 89.4 ± 29.4 months. 63 eyes had CE and the probability of CE following DS was 0% at 1, 11.6% at 3, 21.0% at 5 and 33.2% at 7 years, with a 50% probability (median survival time) of 10 years. Age was association with increased risk for CE (Hazard ratio 1.05, 95% CI: 1.03-1.08, p < 0.0001). Mean IOP had increased from 11 mmHg to 15 mmHg in the first 3 months and remained higher up to a year (p < 0.001). There was no difference in the probability of maintaining an IOP < 16 mmHg without additional medications or needle revision (p = 0.05,Log-rank test). 20/47 eyes that failed were from the CE group, of which 14 (22.2%) failed prior to CE. Number of eyes on glaucoma medications before CE was 6 (mean edications 0.2 ± 0.5 m) and by last follow-up, 9 eyes were on medications (mean medications 0.2 ± 0.7). Post-CE needle revision was performed on 4 eyes.
CONCLUSIONS
The probability of CE after DS is low, with a gradual increase with time. Increasing age was found to be a statistically significant risk factor. There was a modest increase in IOP after CE and increase use of glaucoma medications.
目的
评估丝裂霉素 C（MMC）下深板层巩膜切除术（DS）后白内障摘除（CE）的发生率和易患因素及其对眼压（IOP）控制的影响。
方法
回顾性研究了 5 年内接受 MMC 下 DS 的有晶状体眼。共纳入 179 例 179 只眼。
结果
DS 时的平均年龄为 68.6±9.7 岁，平均随访时间为 89.4±29.4 个月。63 只眼行 CE，DS 后 CE 的概率分别为 0%（1 年）、11.6%（3 年）、21.0%（5 年）和 33.2%（7 年），50%（中位生存时间）概率为 10 年。年龄与 CE 风险增加相关（危险比 1.05，95%CI：1.03-1.08，p<0.0001）。术后 3 个月内 IOP 从 11mmHg 升高至 15mmHg，1 年内仍较高（p<0.001）。无需额外药物或针修订维持 IOP<16mmHg 的概率无差异（p=0.05，Log-rank 检验）。20/47 只失代偿眼来自 CE 组，其中 14 只（22.2%）在 CE 前失代偿。CE 前接受抗青光眼药物治疗的眼数为 6 只（平均用药 0.2±0.5m），末次随访时 9 只眼接受药物治疗（平均用药 0.2±0.7m）。CE 后有 4 只眼行针修订术。
结论
DS 后 CE 的概率较低，随时间逐渐增加。发现年龄增长是一个具有统计学意义的危险因素。CE 后眼压略有升高，抗青光眼药物的使用增加。
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