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无虹膜相关性青光眼继发青光眼行小梁切除联合丝裂霉素 C 与青光眼引流器植入术后的疗效比较。

Outcomes of Glaucoma Drainage Device Implantation and Trabeculectomy With Mitomycin C in Glaucoma Secondary to Aniridia.

机构信息

Aravind Eye Hospital, Madurai, India.

Aravind Eye Hospital, Madurai, India.

出版信息

Am J Ophthalmol. 2021 Jul;227:173-181. doi: 10.1016/j.ajo.2021.03.008. Epub 2021 Mar 15.

Abstract

PURPOSE

To compare the outcomes of Aurolab aqueous drainage implant (AADI; Aurolab) placement and trabeculectomy with mitomycin C (MMC) in patients with glaucoma secondary to aniridia.

DESIGN

Retrospective comparative interventional case series.

METHODS

This study included patients with congenital aniridia who underwent AADI implantation or trabeculectomy with MMC. Surgical failure was defined as IOP > 21 mm Hg or reduced <20% from baseline, IOP ≤ 5 mm Hg, reoperation for glaucoma or a complication, or loss of light perception vision.

RESULTS

A total of 30 eyes of 30 patients underwent surgical treatment, including 18 eyes that received an AADI and 12 eyes that had a trabeculectomy with MMC. The cumulative probability of failure at 2 years was 11.1% (95% CI = 2.9%-37.6%) in the AADI group and 58.3% (95% CI = 33.5%-84.8%) in the trabeculectomy group (P = .05, log-rank). At 2 years, IOP (mean ± SD) was 14.1 ± 2.8 mm Hg in the AADI group and 19.6 ± 6.6 mm Hg in the trabeculectomy group (P = .02), and the number of glaucoma medications was 1.7 ± 0.9 in the AADI group and 2.2 ± 0.8 in the trabeculectomy group (P = .25). Surgical complications developed in 1 patient in each treatment group (P = .65). Cataract surgery was performed in 5 (42%) patients in the trabeculectomy group and no patients in the AADI group (P = .01).

CONCLUSIONS

Placement of an AADI resulted in lower IOP and a higher rate of surgical success compared to trabeculectomy with MMC in eyes with glaucoma associated with aniridia. Cataract extraction was more frequently required after trabeculectomy with MMC than AADI implantation.

摘要

目的

比较房水引流植入物( Aurolab )和丝裂霉素 C ( MMC )小梁切除术治疗无虹膜性青光眼的疗效。

设计

回顾性比较干预性病例系列研究。

方法

本研究纳入了接受 Aurolab 植入或 MMC 小梁切除术的先天性无虹膜性青光眼患者。手术失败定义为眼压( IOP )> 21mmHg 或较基线降低<20%,IOP ≤ 5mmHg ,青光眼或并发症再次手术,或光感丧失。

结果

共有 30 例(30 只眼)患者接受了手术治疗,其中 18 只眼接受了 Aurolab 植入,12 只眼接受了 MMC 小梁切除术。2 年时, Aurolab 组的累积失败概率为 11.1%(95%可信区间为 2.9%-37.6%),而 MMC 小梁切除术组为 58.3%(95%可信区间为 33.5%-84.8%)( P =.05 ,对数秩)。2 年时, Aurolab 组的眼压(平均值±标准差)为 14.1±2.8mmHg ,而 MMC 小梁切除术组为 19.6±6.6mmHg ( P =.02 ), Aurolab 组的降眼压药物数量为 1.7±0.9 ,而 MMC 小梁切除术组为 2.2±0.8 ( P =.25 )。每组各有 1 例患者发生手术并发症( P =.65 )。在 MMC 小梁切除术组中有 5 例(42%)患者行白内障手术,而 Aurolab 组无患者行白内障手术( P =.01 )。

结论

与 MMC 小梁切除术相比,房水引流植入物治疗无虹膜性青光眼可降低眼压,提高手术成功率。与 Aurolab 植入相比, MMC 小梁切除术后更常需要行白内障手术。

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