Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Minami-ku Hiroshima, Japan.
Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Acta Ophthalmol. 2020 Feb;98(1):e81-e87. doi: 10.1111/aos.14195. Epub 2019 Jul 25.
To examine the efficacy and safety of current trabeculectomy with mitomycin C in Japan for glaucomatous eyes with low intraocular pressure (IOP).
Two hundred ninety-four eyes of 294 patients with IOP ≤21 mmHg before surgery were studied; all patients were participants in the Collaborative Bleb-related Infection Incidence and Treatment Study (CBIITS), a multicentre, prospective, cohort study conducted at 34 ophthalmological institutions throughout Japan. All eyes had an intraocular pressure ≤ 21 mmHg and had undergone trabeculectomy alone or phacotrabeculectomy. Two success criteria were used: Criterion A comprised 20% reduction of baseline IOP and Criterion B comprised 30% reduction of baseline IOP. The primary outcome was the success rate for each of these criteria.
The qualified success rates were 87.3% for Criterion A and 42.0% for Criterion B at 5 years. Mean IOP was significantly reduced, from 16.7 ± 2.7 to 11.6 ± 4.0 mmHg at 5 years after trabeculectomy (p < 0.0001); the number of anti-glaucoma medications significantly decreased from 2.7 ± 1.1 to 1.0 ± 1.2 (p < 0.0001) at 5 years after the surgery. Three or more trabeculectomies, and needling were related to increased risk of failure. Incidences of postoperative hyphema, infection, shallow anterior chamber and bleb leakage were 2.4%, 2.4%, 2.0% and 3.4%, respectively.
This study showed that trabeculectomy with mitomycin C is an effective procedure with few surgical complications for reducing IOP in patients, even if preoperative IOP was within the normal range.
研究在日本，对于眼压（IOP）较低的青光眼眼，行含丝裂霉素 C 的小梁切除术的疗效和安全性。
对 294 例 294 只眼进行了研究，这些眼术前 IOP 均≤21mmHg；所有患者均为日本 34 家眼科机构参与的多中心前瞻性队列研究——眼滤过泡相关性感染和治疗研究（CBIITS）的参与者。所有眼的 IOP 均≤21mmHg，均单独行小梁切除术或超声乳化白内障吸除术联合小梁切除术。采用 2 种成功标准：标准 A 为基础眼压降低 20%，标准 B 为基础眼压降低 30%。主要结局为这 2 种标准的成功率。
术后 5 年，标准 A 的合格成功率为 87.3%，标准 B 的合格成功率为 42.0%。术后 5 年，平均眼压从 16.7±2.7mmHg 显著降低至 11.6±4.0mmHg（p<0.0001）；术后 5 年，抗青光眼药物的数量从 2.7±1.1 降至 1.0±1.2（p<0.0001）。行 3 次或以上小梁切除术和针刺术与手术失败风险增加相关。术后发生前房积血、感染、浅前房和滤过泡渗漏的比例分别为 2.4%、2.4%、2.0%和 3.4%。
本研究表明，即使术前 IOP 处于正常范围，对于眼压较低的患者，行含丝裂霉素 C 的小梁切除术是一种有效且并发症少的降低眼压的手术。
