Brusini Paolo, Papa Veronica, Zeppieri Marco
Department of Ophthalmology, Policlinico Città di Udine, Viale Venezia 410, 33100 Udine, Italy.
Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy.
J Clin Med. 2022 Apr 30;11(9):2532. doi: 10.3390/jcm11092532.
Purpose: The aim of this study was to assess the long-term outcomes of canaloplasty surgery in pseudoexfoliation glaucoma (PEXG) patients. Material and Methods: A total of 116 PEXG patients with an intraocular pressure (IOP) > 21 mm/Hg and maximum tolerated local medical therapy who underwent canaloplasty from February 2008 to January 2022 were considered. Every six months, all subjects underwent a complete ophthalmic examination. The period of follow-up ranged from 2 to 167 months. Inclusion criteria included only patients for whom the entire procedure could be completed with a follow-up of at least 2 years. Results: Amongst the 116 PEXG patients, the entire procedure could not be performed in 10 eyes (8.6%), and thus they were not considered in the analysis. Twenty-three patients did not reach the two-year follow-up and another 16 patients during this time period were lost. A total of 67 patients with a mean follow-up of 49 ± 32.3 months were considered in the analysis. The pre-operative mean IOP was 31.2 ± 8.7 mm/Hg (range 20−60). The mean IOP at the two-year follow-up was 17.2 ± 6.7 mmHg, with a mean reduction from baseline of 44.9%. After two years, the qualified success rates according to three different criteria (IOP ≤ 21, ≤18 and ≤16 mmHg) were 80.6%, 73.1% and 61.0%, respectively. The total number of medications used pre- and at the follow-up at 2 years was 3.5 ± 0.8 and 1.2 ± 1.4, respectively. Early complications included: hyphema, in about 30% of cases; Descemet membrane detachment (4.9%); and IOP spikes > 10 mmHg (9.7%). A late failure with an acute IOP rise of up to 50 mmHg was observed in 41 cases (61.2%) after 3 to 72 months. Conclusions: Long-term post-operative outcomes of canaloplasty in PEXG patients appear to be quite good on average; however, an acute rise in IOP can be observed in more than 60% of the cases after a long period of satisfactory IOP control. For this reason, canaloplasty may not be suitable in eyes with PEXG, especially in patients with severe functional damage.
本研究旨在评估剥脱性青光眼（PEXG）患者行睫状体光凝术的长期疗效。材料与方法：纳入2008年2月至2022年1月期间接受睫状体光凝术的116例PEXG患者，这些患者眼压（IOP）>21 mmHg且接受了最大耐受量的局部药物治疗。每6个月对所有受试者进行一次全面的眼科检查。随访时间为2至167个月。纳入标准仅包括整个手术能够完成且随访至少2年的患者。结果：在116例PEXG患者中，10只眼（8.6%）无法完成整个手术，因此未纳入分析。23例患者未达到2年随访，在此期间另有16例患者失访。分析中纳入了67例患者，平均随访时间为49±32.3个月。术前平均眼压为31.2±8.7 mmHg（范围20−60）。2年随访时的平均眼压为17.2±6.7 mmHg，较基线平均降低44.9%。2年后，根据三种不同标准（IOP≤21、≤18和≤16 mmHg）的合格成功率分别为80.6%、73.1%和61.0%。术前及2年随访时使用的药物总数分别为3.5±0.8和1.2±1.4。早期并发症包括：约30%的病例出现前房积血；后弹力层脱离（4.9%）；眼压峰值>10 mmHg（9.7%）。3至72个月后，41例（61.2%）患者出现急性眼压升高至50 mmHg的晚期失败情况。结论：PEXG患者行睫状体光凝术的术后长期疗效总体似乎相当不错；然而，在长时间眼压控制良好后，超过60%的病例可观察到眼压急性升高。因此，睫状体光凝术可能不适用于PEXG患者的眼睛，尤其是功能损害严重的患者。
