Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, 34093, Capa, Istanbul, Turkey.
Glaucoma Department, Istanbul Eye Hospital, Bahcelievler, Istanbul, Turkey.
Int Ophthalmol. 2020 Jun;40(6):1517-1529. doi: 10.1007/s10792-020-01321-8. Epub 2020 Feb 25.
This study aimed to compare the 1-year postoperative phacoemulsification-trabeculectomy (P-Trab) and phacoemulsification-ExPRESS (P-200 model) miniature shunt (P-ExPRESS) combined surgeries.
This retrospective, comparative clinical study investigated 41 eyes of 41 patients diagnosed with open-angle glaucoma and cataract. Of these, 21 eyes underwent P-Trab surgery and 20 eyes underwent P-ExPRESS surgery. The 1-year follow-up results, including intraocular pressure (IOP), visual acuity (VA), medications, and complications, were reviewed and compared. A 5 ≤ IOP ≤ 18 mmHg or 30% reduction from baseline was defined as Qualified Success (QS-1), and target IOP without medication was defined as Complete Success (CS-1). A 5 ≤ IOP ≤ 15 mmHg or 40% reduction from baseline was defined as Qualified Success (QS-2), and target IOP without medication was defined as Complete Success (CS-2).
The mean follow-up time was 16 months (12-26 months). Results after the twelfth month for P-Trab versus P-ExPRESS are: CS-1: 42.8% versus 60.0% (P = 0.354); QS-1: 86.7% versus 95% (P = 0.606); CS-2:33.3% versus 40% (P = 0.751); QS-2: 66.6% versus 75% (P = 0.733). Kaplan-Meier survival analysis was not statistically significant between two groups for both QS-1, CS-1 and QS-2, CS-2 (P = 0.329 vs P = 0.365, P = 0.765 vs P = 0.789, respectively). Pre-op mean IOP was: 33.19 ± 8.7 versus 34.55 ± 11.3 mmHg; post-op mean IOP was: 15.19 ± 3.07 versus 15.30 ± 3.32 mmHg (P = 0.913); pre-op mean VA was: 1.17 ± 1.04 versus 1.15 ± 1.07 logMAR; and post-op mean VA was: 0.61 ± 0.80 versus 0.66 ± 0.99 logMAR (P = 0.869). The pre-op mean number of antiglaucomatous medications was 3.76 ± 0.53 versus 3.30 ± 1.45, and the post-op results were 1.52 ± 1.53 versus 0.85 ± 1.26 (P = 0.135). Comparing the pre-op and post-op values, both types of surgeries were equally effective (P = 0.00). Surgical failure was 14.2% (3/21) versus 5% (1/20), and the incidence ratios of significant complications were: 47% (10/21) versus 10% (2/20) and P-Trab versus P-ExPRESS, respectively (P = 0.015).
The 1-year postoperative results suggest that P-ExPRESS is as effective as P-Trab, with fewer complications.
本研究旨在比较 1 年后行超声乳化白内障吸除术联合小梁切除术（P-Trab）和超声乳化白内障吸除术联合 ExPRESS 微导管（P-ExPRESS）的疗效。
本回顾性、对照性临床研究纳入了 41 例（41 只眼）被诊断为开角型青光眼合并白内障的患者。其中，21 只眼接受了 P-Trab 手术，20 只眼接受了 P-ExPRESS 手术。回顾并比较了 1 年随访时的眼压（IOP）、视力（VA）、药物使用和并发症等结果。眼压 518mmHg 或较基线下降 30%定义为合格成功（QS-1），无需药物治疗的目标眼压定义为完全成功（CS-1）。眼压 515mmHg 或较基线下降 40%定义为合格成功（QS-2），无需药物治疗的目标眼压定义为完全成功（CS-2）。
平均随访时间为 16 个月（12~26 个月）。P-Trab 与 P-ExPRESS 手术后第 12 个月的结果如下：CS-1：42.8%比 60.0%（P=0.354）；QS-1：86.7%比 95%（P=0.606）；CS-2：33.3%比 40%（P=0.751）；QS-2：66.6%比 75%（P=0.733）。Kaplan-Meier 生存分析显示两组间 QS-1、CS-1 和 QS-2、CS-2 的差异均无统计学意义（P=0.329 比 P=0.365，P=0.765 比 P=0.789）。术前平均 IOP 为 33.19±8.7mmHg 比 34.55±11.3mmHg；术后平均 IOP 为 15.19±3.07mmHg 比 15.30±3.32mmHg（P=0.913）；术前平均 VA 为 1.17±1.04logMAR 比 1.15±1.07logMAR；术后平均 VA 为 0.61±0.80logMAR 比 0.66±0.99logMAR（P=0.869）。术前平均抗青光眼药物使用数量为 3.76±0.53 比 3.30±1.45，术后分别为 1.52±1.53 比 0.85±1.26（P=0.135）。两种手术类型的术前和术后结果均有效（P=0.00）。手术失败率为 14.2%（3/21）比 5%（1/20），显著并发症发生率分别为 47%（10/21）比 10%（2/20），P-Trab 比 P-ExPRESS（P=0.015）。
1 年后的术后结果表明，P-ExPRESS 与 P-Trab 同样有效，且并发症更少。
