Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Glaucoma and Cataract Unit, Magrabi Hospitals and Centers, Cairo, Egypt.
Int Ophthalmol. 2021 May;41(5):1613-1624. doi: 10.1007/s10792-021-01698-0. Epub 2021 Feb 6.
To study midterm efficacy and safety of combined Visco-Trab operation for management of advanced glaucoma.
168 eyes of 148 patients with advanced glaucoma had Visco-Trab operation (a merge of both viscocanalostomy and trabeculectomy operations). Mean follow-up was 29.1 ± 22.2 months. Criteria of success were intraocular pressure (IOP) of 14 mmHg or less with or without glaucoma medications, with no devastating complications, loss of light perception, or additional glaucoma surgery.
IOP, number of glaucoma drops, and visual field mean deviation were significantly reduced (11.9 ± 5.6 mmHg, 0.7 ± 1.2, and 14.2 ± 6.3 dB, compared to preoperative values of 24.4 ± 9.9 mmHg, 2.8 ± 1.4, and 17.3 ± 6.3 dB, respectively). Success was reported in 136 of 168 eyes (81%) without (100 eyes, 59.5%) or with (36 eyes, 21.5%) glaucoma medications. A functioning bleb was seen in 2/3rd of eyes; diffuse (59 eyes, 35%) and thin ischemic (54 eyes, 32%). Predictors for failure to achieve the target IOP included previous ocular (p = 0.01) or glaucoma (p = 0.04) surgery, number of preoperative glaucoma medications (p = 0.029), and severity of glaucoma (p = 0.058).
Combined Visco-Trab operation proved safe and effective, on midterm follow-up, in reducing IOP to the proposed target level in eyes with severe glaucoma via enhancing internal and external filtration.
研究联合粘小管手术治疗晚期青光眼的中期疗效和安全性。
对 148 例（168 只眼）晚期青光眼患者行粘小管手术（粘小管切开术和小梁切除术的联合手术）。平均随访 29.1±22.2 个月。成功的标准为眼压（IOP）为 14mmHg 或以下，无需或无需使用青光眼药物，无严重并发症、光感丧失或额外的青光眼手术。
与术前的 24.4±9.9mmHg、2.8±1.4 和 17.3±6.3dB 相比，IOP、降眼压药物的数量和视野平均偏差明显降低（11.9±5.6mmHg、0.7±1.2 和 14.2±6.3dB）。168 只眼中有 136 只（81%）报告成功，无需（100 只眼，59.5%）或需要（36 只眼，21.5%）降眼压药物。三分之二的眼可见功能滤过泡；弥漫性（59 只眼，35%）和薄缺血性（54 只眼，32%）。不能达到目标眼压的预测因素包括先前的眼部（p=0.01）或青光眼（p=0.04）手术、术前降眼压药物的数量（p=0.029）和青光眼的严重程度（p=0.058）。
在中期随访中，联合粘小管手术通过增强内、外滤过，安全有效地将严重青光眼患者的眼压降低到建议的目标水平。
