一项前瞻性试点研究，比较长期高强度皮质类固醇治疗与标准治疗的深层巩膜切除术效果。
Prospective pilot study comparing deep sclerectomy outcomes with a long-term and intense corticosteroid treatment versus a standard one.
作者信息
Lanzagorta-Aresti Aitor, Perez-Lopez Marta, Davo-Cabrera Juan Maria, Palacios-Pozo Elena
机构信息
Glaucoma and Neuro-Ophthalmology Department, FISABIO Oftalmologia, Valencia, Spain.
出版信息
BMJ Open Ophthalmol. 2018 Oct 31;3(1):e000165. doi: 10.1136/bmjophth-2018-000165. eCollection 2018.
OBJECTIVE
To compare prospectively intraocular pressure (IOP) results after deep sclerectomy (DS) using a topical short-term corticosteroid treatment (STCT, 1 month) versus a topical long-term and intense corticosteroid treatment (LTCT, 6 months) in a two2 year-follow-up.
METHODS
Patients with medically uncontrolled open angle glaucoma were prospectively recruited and underwent a DS.
RESULTS
We operated 45 eyes of 45 patients, 22 in STCT group and 23 in LTCT group. Median preoperative IOP was 27 (22-36.75) mm Hg for STCT and for 25 (22-28) mm Hg for LTCT group without significant difference (p=0.195). Median postoperative IOP was 4 (3-6.25) mm Hg in STCT group versus 2 (0-5) mm Hg in LTCT at day 1 (p=0.003); 8.5 (5.75-11.25) mm Hg (STCT) vs 6 (4-9) mm Hg (LTCT) at week 1 (p=0.079); 17.5 (14.75-22.25) mm Hg (STCT) vs 13 (10-14) mm Hg (LTCT) at month 1 (p=0.001); 16 (12-20) mm Hg (STCT) vs 12 (10-15) mm Hg (LTCT) at month 3 (p=0.008); 17 (14-20) mm Hg (STCT) vs 12 (10-14) mm Hg (LTCT) at month 6 (p=0.000); 16 (14-20) mm Hg (STCT) vs 14 (10-16) mm Hg (LTCT) at year 1 (p=0.002) and 17.5 (15-19) mm Hg (STCT) vs 14 (12-16) mm Hg (LTCT) at year 2 (p=0.001). The complete success rate was 54.5 % in STCT and 87 % in LTCT (p=0.018).
CONCLUSIONS
A long-term and intensive postoperative treatment enhances success rate in DS compared with a standard protocol.
目的
前瞻性比较在为期2年的随访中，使用局部短期皮质类固醇治疗（STCT，1个月）与局部长期强化皮质类固醇治疗（LTCT，6个月）的深层巩膜切除术（DS）后的眼压（IOP）结果。
方法
前瞻性招募药物治疗无法控制的开角型青光眼患者并进行DS手术。
结果
我们为45例患者的45只眼进行了手术，STCT组22只眼，LTCT组23只眼。STCT组术前眼压中位数为27（22 - 36.75）mmHg，LTCT组为25（22 - 28）mmHg，无显著差异（p = 0.195）。术后第1天，STCT组眼压中位数为4（3 - 6.25）mmHg，LTCT组为2（0 - 5）mmHg（p = 0.003）；第1周时，分别为8.5（5.75 - 11.25）mmHg（STCT）和6（4 - 9）mmHg（LTCT）（p = 0.079）；第1个月时，分别为17.5（14.75 - 22.25）mmHg（STCT）和13（10 - 14）mmHg（LTCT）（p = 0.001）；第3个月时，分别为16（12 - 20）mmHg（STCT）和12（10 - 15）mmHg（LTCT）（p = 0.008）；第6个月时，分别为17（14 - 20）mmHg（STCT）和12（10 - 14）mmHg（LTCT）（p = 0.000）；第1年时，分别为16（14 - 20）mmHg（STCT）和14（10 - 16）mmHg（LTCT）（p = 0.002）；第2年时，分别为17.5（15 - 19）mmHg（STCT）和14（12 - 16）mmHg（LTCT）（p = 0.001）。STCT组的完全成功率为54.5%，LTCT组为87%（p = 0.018）。
结论
与标准方案相比，术后长期强化治疗可提高DS的成功率。
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