窄角型青光眼患者行粘小管切开术和超声乳化粘小管切开术的长期疗效
Long-term outcomes of viscocanalostomy and phaco-viscocanalostomy in patients with narrow angle glaucoma.
作者信息
Berman Tasmin, Somerville Tobi, Choudhary Anshoo
机构信息
St Pauls Eye Unit, Liverpool University Hospital, Liverpool, UK.
出版信息
Graefes Arch Clin Exp Ophthalmol. 2022 Jun;260(6):1995-2002. doi: 10.1007/s00417-021-05497-2. Epub 2021 Nov 24.
PURPOSE
To assess the outcomes of viscocanalostomy and phaco-viscocanalostomy in patients with narrow angle glaucoma at a single tertiary eye centre.
METHOD
All patients undergoing viscocanalostomy for narrow angle glaucoma between June 2010 and June 2017 with a minimum follow-up of 12 months were included. Data was analysed from a prospectively maintained surgical outcome database. Primary outcome was a change in intraocular pressure (IOP). Secondary outcomes were changes in LogMAR visual acuity, number of eye drops, post-operative complications and further surgical interventions. Success was defined at two IOP cut-off points: IOP ≤ 21 mmHg and IOP ≤ 15 mmHg with (qualified success) or without (complete success) drops. Failure was any repeat glaucoma surgery or loss of light perception.
RESULTS
Seventy eyes of 46 patients with a mean follow-up of 41.31 months (range 12-60 months) were included. Mean IOP changed from 25.7 ± 9.6 to 15.2, 15.6, 14.6, 13.8 and 14.0 mmHg at 1, 2, 3, 4 and 5 years post-operatively. Drops reduced from 3.2 ± 1.1 pre-operatively to 0.5 at 1 year and 1.1 at all time points thereafter. Qualified success for an IOP ≤ 21 mmHg was achieved in 94.2%, 88.1%, 92.5%, 91.1% and 92.0% and complete success in 63.8%, 37.3%, 30.2%, 22.2% and 24.0% in years 1 to 5, respectively. Qualified success for an IOP ≤ 15 mmHg was achieved in 53.6%, 60.9%, 69.8%, 68.9% and 64.0% and complete success in 39.1%, 26.9%, 22.6%, 20.0% and 8.0% in years 1 to 5, respectively. IOP was significantly lower at all examined post-operative time points (41.1%, 39.3%, 43.3%, 46.4% and 45.3% at years 1 to 5, respectively, p < 0.001 at all time points). Four eyes (5.7%) failed to meet any of the success criteria. Of these, 3 eyes (4.3%) required further glaucoma surgery and one eye (1.4%) progressed to no perception of light at 48 months. No patients had an IOP ≤ 5 mmHg on two consecutive occasions after 3 months.
CONCLUSION
Viscocanalostomy and phaco-viscocanalostomy are a safe and effective surgical option in the management of chronic narrow angle glaucoma.
目的
在一家三级眼科中心评估粘性小管切开术和超声乳化-粘性小管切开术治疗窄角型青光眼患者的疗效。
方法
纳入2010年6月至2017年6月期间接受粘性小管切开术治疗窄角型青光眼且随访至少12个月的所有患者。数据来自前瞻性维护的手术结果数据库。主要结局是眼压（IOP）的变化。次要结局是LogMAR视力、滴眼液数量、术后并发症及进一步手术干预的变化。成功定义为两个眼压切点：眼压≤21 mmHg且使用（合格成功）或不使用（完全成功）滴眼液；眼压≤15 mmHg。失败定义为任何重复的青光眼手术或光感丧失。
结果
纳入46例患者的70只眼，平均随访41.31个月（范围12 - 60个月）。术后1、2、3、4和5年时，平均眼压分别从25.7±9.6降至15.2、15.6、14.6、13.8和14.0 mmHg。术前滴眼液平均为3.2±1.1种，术后1年降至0.5种，此后各时间点均为1.1种。第1至5年，眼压≤21 mmHg的合格成功率分别为94.2%、88.1%、92.5%、91.1%和92.0%，完全成功率分别为63.8%、37.3%、30.2%、22.2%和24.0%。第1至5年，眼压≤15 mmHg的合格成功率分别为53.6%、60.9%、69.8%、68.9%和64.0%，完全成功率分别为39.1%、26.9%、22.6%、20.0%和8.0%。所有术后检查时间点眼压均显著降低（第1至5年分别为41.1%、39.3%、43.3%、46.4%和45.3%，所有时间点p<0.001）。4只眼（5.7%）未达到任何成功标准。其中，3只眼（4.3%）需要进一步的青光眼手术，1只眼（1.4%）在48个月时进展为无光感。3个月后没有患者连续两次眼压≤5 mmHg。
结论
粘性小管切开术和超声乳化-粘性小管切开术是治疗慢性窄角型青光眼的安全有效的手术选择。
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