超声乳化白内障吸除术联合小梁切除术与超声乳化白内障吸除术联合 ExPRESS 微型分流器手术的 1 年术后结果比较。
Comparison of the 1-year postoperative results of phacoemulsification-trabeculectomy and phacoemulsification-ExPRESS miniature shunt combined surgeries.
机构信息
Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, 34093, Capa, Istanbul, Turkey.
Glaucoma Department, Istanbul Eye Hospital, Bahcelievler, Istanbul, Turkey.
出版信息
Int Ophthalmol. 2020 Jun;40(6):1517-1529. doi: 10.1007/s10792-020-01321-8. Epub 2020 Feb 25.
BACKGROUND AND OBJECTIVE
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.
MATERIALS AND METHODS
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).
RESULTS
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).
CONCLUSION
The 1-year postoperative results suggest that P-ExPRESS is as effective as P-Trab, with fewer complications.
背景与目的
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。
材料与方法
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）。
结果
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）。
结论
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。
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