Iwasaki Kentaro, Kakimoto Hiroshi, Orii Yusuke, Arimura Shogo, Takamura Yoshihiro, Inatani Masaru
Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan.
Department of Ophthalmology, Obama Hospital, Fukui 917-0078, Japan.
J Clin Med. 2022 Mar 1;11(5):1354. doi: 10.3390/jcm11051354.
We retrospectively evaluated the long-term surgical outcomes of phacoemulsification combined with a Kahook dual blade (KDB) procedure in Japanese patients with open-angle glaucoma. The primary outcome was surgical success or failure. Surgical failure was indicated by a <20% reduction in preoperative intraocular pressure (IOP) or IOP > 18 mmHg (criterion A), IOP > 14 mmHg (criterion B), or requirement for reoperation. Glaucoma medications after surgery and postoperative complications were recorded. Surgical outcomes were compared between primary open-angle glaucoma (POAG) and exfoliation glaucoma (ExG) groups. The probability of success at 36 months postoperation was 52.5% using criterion A and 36.9% using criterion B. Mean IOP decreased significantly from 19.5 ± 6.9 mmHg preoperatively to 11.9 ± 2.7 mmHg at 36 months, and the mean number of glaucoma medications from 2.4 ± 1.4 to 1.6 ± 1.4 (both p < 0.01). IOP spikes were significantly more common in the ExG group (23.7% vs. 9.1%; p = 0.045), as was the need for additional glaucoma surgery (10.5% vs. 1.8%; p = 0.038). A KDB procedure combined with cataract surgery resulted in significant long-term decreases in IOP and the number of glaucoma medications. The complication rate was higher in eyes with ExG. Therefore, these eyes require more careful management after a KDB procedure.
我们回顾性评估了超声乳化联合Kahook双刃刀（KDB）手术治疗日本开角型青光眼患者的长期手术效果。主要结局为手术成功或失败。手术失败的指征为术前眼压（IOP）降低<20%或IOP>18 mmHg（标准A）、IOP>14 mmHg（标准B）或需要再次手术。记录术后青光眼用药情况和术后并发症。比较原发性开角型青光眼（POAG）组和剥脱性青光眼（ExG）组的手术效果。采用标准A时，术后36个月的成功率为52.5%，采用标准B时为36.9%。平均IOP从术前的19.5±6.9 mmHg显著降至36个月时的11.9±2.7 mmHg，青光眼用药的平均数量从2.4±1.4降至1.6±1.4（均p<0.01）。IOP峰值在ExG组明显更常见（23.7%对9.1%；p=0.045），需要额外青光眼手术的情况也是如此（10.5%对1.8%；p=0.038）。KDB手术联合白内障手术导致IOP和青光眼用药数量长期显著下降。ExG患眼的并发症发生率更高。因此，这些患眼在KDB手术后需要更仔细的管理。
