Perez-Grossmann Rodolfo A, Grigera Daniel E, Wenger Alan
Instituto de Glaucoma y Catarata, Lima, Peru.
Glaucoma Service, Hospital Oftalmológico Santa Lucía, Buenos Aires, Argentina.
Ophthalmol Ther. 2019 Jun;8(2):323-331. doi: 10.1007/s40123-019-0179-5. Epub 2019 Mar 16.
The aim of this study was to evaluate the efficacy of trabeculectomy with suprachoroidal derivation in eyes with uncontrolled glaucoma after a 24-month follow-up period.
This was a prospective uncontrolled non-randomized case series. All patients scheduled for a trabeculectomy due to uncontrolled glaucoma at the "Instituto de Glaucoma y Catarata" (Lima, Peru) between 2011 and 2014 were included. Thee patients underwent trabeculectomy with mitomycin C and suprachoroidal derivation with two autologous scleral flaps. Postsurgical follow-up visits took place on day 1, and at 1, 6, 12, 18 and 24 months. Best corrected visual acuity (BCVA), intraocular pressure (IOP) and complications at each control were registered. Main outcome measures were IOP reduction, number of glaucoma medications and complication rate. Postoperative IOP of > 21 mmHg, < 5 mmHg, additional glaucoma surgery or severe complications were considered as indications of failure.
Thirty-three participants (41 eyes) were included in the study, of whom 27 (81.82%) (31 eyes [75.61%]) finished the 24 months of follow-up. At the end of the follow-up, mean IOP had decreased by 11.29 ± 9.32 mmHg (p < 0.001), and glaucoma medication usage in 25 (25/31; 80.65%) eyes had stopped. Ten (10/41; 24.39%) patients complained of blurred vision, and 15 (15/41; 36.59%) patients referred to foreign body sensation the first day after surgery; both sensations resolved spontaneously after 1 week in all cases. No failures, significant changes in BCVA (p = 0.387) or severe complications were found.
In this case series, trabeculectomy with suprachoroidal derivation exhibited high efficacy and safety after a 24-month follow-up. A larger sample with a control group is needed to confirm our initial findings.
本研究的目的是评估在24个月的随访期后，小梁切除术联合脉络膜上腔引流术治疗眼压控制不佳的青光眼的疗效。
这是一项前瞻性非对照非随机病例系列研究。纳入了2011年至2014年期间在秘鲁利马“青光眼与白内障研究所”因眼压控制不佳而计划接受小梁切除术的所有患者。这些患者接受了丝裂霉素C小梁切除术和两块自体巩膜瓣脉络膜上腔引流术。术后随访在第1天以及1、6、12、18和24个月进行。记录每次检查时的最佳矫正视力（BCVA）、眼压（IOP）和并发症情况。主要观察指标为眼压降低情况、青光眼药物使用数量和并发症发生率。术后眼压>21 mmHg、<5 mmHg、额外的青光眼手术或严重并发症被视为失败的指征。
本研究纳入了33名参与者（41只眼），其中27名（81.82%）（31只眼[75.61%]）完成了24个月的随访。随访结束时，平均眼压降低了11.29±9.32 mmHg（p<0.001），25只眼（25/31；80.65%）停止使用青光眼药物。10名（10/41；24.39%）患者抱怨视力模糊，15名（15/41；36.59%）患者在术后第一天提及有异物感；所有这些感觉在1周后均自行消失。未发现失败病例、BCVA有显著变化（p = 0.387）或严重并发症。
在这个病例系列中，小梁切除术联合脉络膜上腔引流术在24个月的随访后显示出高疗效和安全性。需要更大样本且有对照组的研究来证实我们的初步发现。
