中文原发性开角型青光眼和假性剥脱性青光眼患者的改良 CO2 激光辅助巩膜切除术：2 年随访研究。
Modified CO2 Laser-assisted Sclerectomy Surgery in Chinese Patients With Primary Open-Angle Glaucoma and Pseudoexfoliative Glaucoma: A 2-Year Follow-up Study.
机构信息
Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences.
Department of Ophthalmology, Peking Union Medical College Hospital, Beijing, China.
出版信息
J Glaucoma. 2020 May;29(5):367-373. doi: 10.1097/IJG.0000000000001460.
PRECIS
A modified CO2 laser-assisted sclerectomy surgery (CLASS) based on the characteristics of Chinese eyeball was carried out in Chinese patient and was confirmed to be effective and safe during long-term follow-up.
PURPOSE
The purpose of this study was to study the long-term efficacy and safety of modified CLASS in Chinese patients with primary open-angle and pseudoexfoliative glaucoma.
METHODS
We enrolled 25 medically uncontrolled primary open-angle and pseudoexfoliative glaucoma patients in this prospective, interventional case series. A combination of modified CLASS and preoperative laser iris management was administered to 29 eyes. Visual acuity, intraocular pressure (IOP), slit-lamp examinations, visual field, and gonioscopy were carried out at baseline and until 24 months postoperatively. Ultrasound biomicroscopy examinations were repeated at 3, 12, and 24 months postsurgically.
RESULTS
Mean patient age was 53.92±12.08 years. Mean preoperative IOP was 30.66±10.41 mm Hg; and mean postoperative IOP was 8.17±3.76, and 13.25±2.73, 13.76±2.50, and 13.76±2.50 mm Hg at 1 day, and 6, 12, and 24 months, respectively. Proportional changes in IOP from baseline at 6, 12, and 24 months was 58.33%, 56.25%, and 58.97% (P<0.001), respectively. Complete postoperative success rates at 12 and 24 months were 62.07% and 48.28%. Qualified success rates at 12 and 24 months postoperatively were both 89.66%. Number of medications administered per patient reduced from 3 at baseline to 0 at 12 and 24 months (P<0.0001). Two patients demonstrated severe peripheral anterior synechiae (6.90%). Ultrasound biomicroscopy examination revealed a severe scleral lake diminution in 1 patient (3.40%) at 12 months and 2 patients (6.90%) at 24 months.
CONCLUSION
Combination of modified CLASS and preventive laser iris management was effective and safe in the long-term treatment of primary open-angle glaucoma patients.
摘要
本文对中国患者施行改良后的 CO2 激光辅助巩膜切除术（CLASS），并根据中国人眼球的特点进行了调整。该手术在长期随访中被证实是有效且安全的。
目的
本研究旨在探讨改良后的 CLASS 手术在原发性开角型和假性剥脱性青光眼中国患者中的长期疗效和安全性。
方法
本前瞻性、干预性病例系列研究纳入 25 例药物控制不佳的原发性开角型和假性剥脱性青光眼患者。对 29 只眼施行改良 CLASS 联合术前激光虹膜管理。在基线和术后 24 个月时进行视力、眼压（IOP）、裂隙灯检查、视野和房角镜检查。术后 3、12 和 24 个月时重复进行超声生物显微镜检查。
结果
患者平均年龄为 53.92±12.08 岁。平均术前 IOP 为 30.66±10.41mmHg；术后 1 天、6 个月、12 个月和 24 个月时的平均 IOP 分别为 8.17±3.76mmHg、13.25±2.73mmHg、13.76±2.50mmHg 和 13.76±2.50mmHg。IOP 从基线的比例变化在 6、12 和 24 个月时分别为 58.33%、56.25%和 58.97%（P<0.001）。术后 12 个月和 24 个月时的完全术后成功率分别为 62.07%和 48.28%。术后 12 个月和 24 个月时的合格成功率均为 89.66%。每位患者的用药数量从基线时的 3 种减少到 12 个月和 24 个月时的 0 种（P<0.0001）。2 例患者出现严重周边前粘连（6.90%）。超声生物显微镜检查显示，1 例患者（3.40%）在术后 12 个月和 2 例患者（6.90%）在术后 24 个月时出现严重巩膜湖缩小。
结论
改良后的 CLASS 联合预防性激光虹膜管理在原发性开角型青光眼患者的长期治疗中是有效且安全的。
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