St Pauls Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.
Graefes Arch Clin Exp Ophthalmol. 2021 Jul;259(7):1965-1974. doi: 10.1007/s00417-021-05144-w. Epub 2021 Mar 8.
Two-year post-operative outcomes of both deep sclerectomy (DS) and trabeculectomy surgery (Trab) augmented with Mitomycin C (MMC) at a single tertiary eye centre.
Retrospective review of DS + MMC and trabeculectomy + MMC at a single centre between February 2015 and March 2018. Patients with a minimum of 12-month follow-up were included. Post-operative follow-up: day 1, week 1, months 1/3/6/12/18/24. Primary outcomes: changes in intraocular pressure (IOP) and changes in LogMAR visual acuity (BCVA) pre- and post-procedure.
changes in number of eye drops, number of follow-up clinic visits, post-operative complications and further surgical interventions. Complete success: IOP ≤ 21 mmHg off all IOP-lowering medications. Qualified success: IOP ≤ 21 mmHg on medication. Failure: IOP > 21 mmHg at 24 months or ≤ 5 mmHg on 2 consecutive follow-up visits after 3 months +/- additional incisional glaucoma surgery +/- loss of light perception. Statistical analysis performed using Microsoft Excel + SPSS.
90 eyes: DS + MMC = 46 eyes, Trab + MMC = 44 eyes. DS + MMC v Trab + MMC: mean pre-op IOP = 19.57 mmHg v 18.89 mmHg, significantly reduced at all post-operative time-points for both groups (p < 0.001). Mean IOP reduction from baseline = 33.94% v 38.39%; > 30% IOP reduction = 54.35% v 68.18%. IOP ≤ 16 mmHg = 82.61% (38/46) v 95.46% (42/44), IOP ≤ 12 mmHg = 52.17% (24/46) v 72.72% (32/44). Complete success = 67.39% v 61.36%, qualified success = 26.09% v 29.55%, failure = 6.52% v 9.09%. Post-op BCVA: no statistically significant differences between two groups (p = 0.09). Mean pre-op drops v post-op drops = 2.98 v 0.38 (DS + MMC; p < 0.001); 2.68 v 0.39 (Trab + MMC; p < 0.001). Further surgical intervention = 13% v 29.55%. Mean number of post-op clinic visits DS + MMC v Trab + MMC = 10.09 v 13.02 (p = 0.005).
Both procedures achieve sustained intraocular pressure and drop reduction at 2 years post-op. DS + MMC has lower complication rates requiring less intervention and significantly fewer clinic visits, which may be an important factor for deciding surgical management of glaucoma patients in the era of Covid-19 to reduce patient/clinician exposure to the virus.
在单一的三级眼科中心，对深板层巩膜切除术（DS）和小梁切除术（Trab）联合丝裂霉素 C（MMC）进行为期 2 年的术后结果比较。
回顾性分析 2015 年 2 月至 2018 年 3 月间在单一中心进行的 DS+MMC 和 Trab+MMC。纳入至少随访 12 个月的患者。术后随访：第 1 天、第 1 周、第 1、3、6、12、18、24 个月。主要结局：术前和术后眼压（IOP）和 LogMAR 视力（BCVA）的变化。次要结局：眼药滴数、随访次数、术后并发症和进一步手术干预的变化。完全成功：IOP 在停用所有降眼压药物后≤21mmHg。合格成功：IOP 在用药后≤21mmHg。失败：24 个月时 IOP＞21mmHg 或在 3 个月后连续 2 次随访时≤5mmHg（加用切口性青光眼手术±光感丧失）。使用 Microsoft Excel+SPSS 进行统计分析。
90 只眼：DS+MMC=46 只眼，Trab+MMC=44 只眼。DS+MMC 与 Trab+MMC 相比：术前平均 IOP=19.57mmHg 比 18.89mmHg，两组在所有术后时间点均显著降低（p＜0.001）。从基线到平均 IOP 降低=33.94%比 38.39%；IOP 降低＞30%=54.35%比 68.18%。IOP≤16mmHg=82.61%（46/56）比 95.46%（44/46），IOP≤12mmHg=52.17%（24/46）比 72.72%（32/44）。完全成功=67.39%比 61.36%，合格成功=26.09%比 29.55%，失败=6.52%比 9.09%。术后 BCVA：两组间无统计学差异（p=0.09）。术前平均用药次数比术后用药次数=2.98 比 0.38（DS+MMC；p＜0.001）；2.68 比 0.39（Trab+MMC；p＜0.001）。进一步手术干预=13%比 29.55%。DS+MMC 比 Trab+MMC 的术后随访次数少=10.09 比 13.02（p=0.005）。
两种手术均可在术后 2 年达到持续的眼压和用药滴数降低。DS+MMC 并发症发生率较低，需要的干预较少，随访次数明显减少，这可能是在新冠疫情时代决定青光眼患者手术管理的一个重要因素，以减少患者/临床医生接触病毒的风险。
