穿透性角膜移植或撕囊内皮角膜移植术后小梁切除术的长期疗效比较及失败的危险因素。
Comparison of long-term outcomes of trabeculectomy and risk factors for failure in eyes post penetrating keratoplasty or Descemet's stripping endothelial keratoplasty.
机构信息
VST Centre for Glaucoma, Hyderabad, Telangana, India.
Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, Telangana, India.
出版信息
Indian J Ophthalmol. 2022 Mar;70(3):827-833. doi: 10.4103/ijo.IJO_1213_21.
PURPOSE
To evaluate the outcomes of trabeculectomy, graft survival, and risk factors for failure in post penetrating keratoplasty (PK) and Descemet's stripping endothelial keratoplasty (DSEK) eyes.
METHODS
We reviewed charts of eyes that underwent trabeculectomy for post keratoplasty glaucoma PK [25 eyes] and DSEK [14 eyes] between 1993 and 2019. The demographics, clinical features, and surgical outcomes were evaluated. Success of trabeculectomy was defined as complete when the intraocular pressure (IOP) was >5 and ≤21 mmHg without antiglaucoma medications (AGM) and qualified with AGM. Clear and compact graft was considered for graft success.
RESULTS
Median (interquartile range [IQR] preoperative IOP in post-PK eyes and post-DSEK eyes was comparable, 32 (28-38) vs. 31.5 (25-36) mmHg, P = 0.38). Median number of preoperative AGMs was comparable (P = 0.78). Median postoperative follow-up was longer in post-PK, compared with post-DSEK, 2.5 (1.3-3.3) vs. 1 (0.3-2.9) years (P = 0.05). Kaplan-Meier survival estimates for complete and qualified success of trabeculectomy at 3 years were 23.7% and 73.3%, respectively, for PK and 45.8% and 71.6%, respectively, for DSEK. Kaplan-Meier survival estimates for graft survival were 91.8% up to 3 years for PK and 100% until 2 years and 77.8% at 3 years for DSEK. Higher IOP prior to trabeculectomy was a risk factor for failure of trabeculectomy (P = 0.03) and older age was a risk factor for graft failure (P = 0.05) in PK eyes. Number of prior corneal surgeries (P = 0.05) was associated with failure of trabeculectomy and graft failure in post-DSEK eyes.
CONCLUSION
Trabeculectomy had moderate qualified success in post-PK and DSEK eyes at 3 years. Higher pretrabeculectomy IOP and higher number of prior corneal surgeries were significantly associated with failure of trabeculectomy in PK and DSEK eyes, respectively.
目的
评估穿透性角膜移植术后（PK）和撕囊内皮角膜移植术后（DSEK）小梁切除术的结果、移植物存活率以及失败的风险因素。
方法
我们回顾了 1993 年至 2019 年间接受小梁切除术治疗 PK [25 只眼]和 DSEK [14 只眼]后青光眼的患者资料。评估了患者的人口统计学、临床特征和手术结果。小梁切除术成功定义为眼压（IOP）>5mmHg 且≤21mmHg，无需抗青光眼药物（AGM）治疗，同时使用 AGM 治疗时为合格。移植物成功定义为透明且致密的移植物。
结果
PK 眼和 DSEK 眼术前 IOP 的中位数（四分位距[IQR]）相近，分别为 32（28-38）mmHg 和 31.5（25-36）mmHg，P=0.38。术前使用 AGM 的中位数数量相近（P=0.78）。与 DSEK 相比，PK 眼的中位术后随访时间更长，分别为 2.5（1.3-3.3）年和 1（0.3-2.9）年（P=0.05）。3 年时小梁切除术完全成功和合格成功的 Kaplan-Meier 生存估计值分别为 23.7%和 73.3%，分别为 PK 眼和 45.8%和 71.6%，分别为 DSEK 眼。PK 眼的移植物 3 年存活率为 91.8%，2 年时为 100%，3 年时为 77.8%。PK 眼术前较高的 IOP 是小梁切除术失败的危险因素（P=0.03），年龄较大是移植物失败的危险因素（P=0.05）。DSEK 眼，术前更多的角膜手术次数（P=0.05）与小梁切除术和移植物失败相关。
结论
小梁切除术在 PK 眼和 DSEK 眼中有中等程度的合格成功率，在 3 年内。PK 眼和 DSEK 眼术前较高的 IOP 和更多的角膜手术次数与小梁切除术失败显著相关。
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