Mansoori Tarannum, Balakrishna Nagalla
Department of Glaucoma, Sita Lakshmi Glaucoma Center, Anand Eye Institute, Hyderabad, Telangana, India.
Department of Statistics, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana, India.
J Curr Ophthalmol. 2020 Dec 12;32(4):329-334. doi: 10.4103/JOCO.JOCO_4_20. eCollection 2020 Oct-Dec.
To compare the safety, efficacy, and outcome measures of a single-site, mitomycin C (MMC)-augmented trabeculectomy combined with phacoemulsification (PT) versus manual small-incision cataract surgery (MSICS) with the posterior chamber intraocular lens (PCIOL) implantation as a primary surgery in the patients with primary glaucoma coexistent with cataract.
From April 2015 to August 2017, medical records of all the patients who underwent combined cataract surgery with PCIOL and MMC augmented trabeculectomy were reviewed. One hundred and thirty-seven eyes met the inclusion criteria. Ninety-seven eyes which underwent PT with MMC were compared with forty eyes that underwent MSICS combined with trabeculectomy (MSICST) MMC. Outcome measures were best corrected visual acuity (BCVA), intraocular pressure (IOP), and number of anti-glaucoma medications (AGM). Complications, if any, were noted in both the groups.
The mean follow-up period after surgery was 18.6 ± 7.7 months (range, 12-40 months). At the last follow-up visit, there was no statistically significant difference between the groups, in terms of mean logMAR BCVA (PT: 0.22 ± 0.31, MSICST: 0.21 ± 0.33, = 0.8), mean IOP reduction (PT: 13.9 ± 2.98 mmHg, MSICST: 14.1 ± 4.12 mmHg, = 0.8), and mean number of AGM (PT: 0.03 ± 0.8, MSICST: 0.025 ± 0.7, = 0.8). Complications were few and transient. One eye in the PT group was considered as a failure and had to undergo needling, repeat trabeculectomy, and later, cyclodestructive procedure. None of the eyes in the MSICST group required an additional procedure for IOP reduction.
There was no difference in the mean IOP reduction, BCVA, and mean number of AGM between the two procedures, and both appeared to be safe and effective techniques as a primary surgery in the patients with coexistent cataract and glaucoma.
比较单切口、丝裂霉素C（MMC）辅助小梁切除术联合超声乳化白内障吸除术（PT）与手法小切口白内障手术（MSICS）联合后房型人工晶状体（PCIOL）植入术作为原发性青光眼合并白内障患者一期手术的安全性、有效性及预后指标。
回顾2015年4月至2017年8月期间所有接受白内障手术联合PCIOL及MMC辅助小梁切除术患者的病历。137只眼符合纳入标准。将97只接受MMC辅助PT的眼与40只接受MSICS联合小梁切除术（MSICST）及MMC的眼进行比较。预后指标包括最佳矫正视力（BCVA）、眼压（IOP）及抗青光眼药物（AGM）使用数量。记录两组的并发症（如有）。
术后平均随访时间为18.6±7.7个月（范围12 - 40个月）。在最后一次随访时，两组在平均logMAR BCVA（PT：0.22±0.31，MSICST：0.21±0.33，P = 0.8）、平均眼压降低值（PT：13.9±2.98 mmHg，MSICST：14.1±4.12 mmHg，P = 0.8）及平均AGM使用数量（PT：0.03±0.8，MSICST：0.025±0.7，P = 0.8）方面无统计学显著差异。并发症较少且为一过性。PT组有1只眼被视为手术失败，不得不接受针刺、重复小梁切除术，随后进行睫状体破坏术。MSICST组无眼因眼压降低需要额外手术。
两种手术在平均眼压降低、BCVA及平均AGM使用数量方面无差异，对于原发性青光眼合并白内障患者作为一期手术而言，两种手术似乎都是安全有效的技术。
