Winuntamalakul Yolradee, Chansangpetch Sunee, Ratanawongphaibul Kitiya, Itthipanichpong Rath, Manassakorn Anita, Tantisevi Visanee, Rojanapongpun Prin
Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society.
Center of Excellence in Glaucoma, Chulalongkorn University, Bangkok, Thailand.
J Glaucoma. 2023 May 1;32(5):374-381. doi: 10.1097/IJG.0000000000002172. Epub 2023 Jan 3.
Phacotrabeculectomy had a significantly lower 24-month failure rate than the isolated trabeculectomy in both the primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) patients. The impact of adding phacoemulsification to trabeculectomy was found to be similar between the eyes with POAG and PACG.
The purpose of this study is to compare the 2-year outcomes of primary mitomycin C-augmented combined phacotrabeculectomy (Phaco+Trab) with isolated trabeculectomy (Trab) in phakic patients with POAG and PACG.
We retrospectively reviewed primary glaucoma patients who underwent mitomycin C-augmented trabeculectomy and completed 2 years of follow-up. Failure rate, postoperative intraocular pressure (IOP), percentage of IOP reduction, and the number of glaucoma medications at 24 months after surgery were compared between the Phaco+Trab and Trab groups.
The study included 146 eyes of 121 patients; 74 underwent Trab and 72 underwent Phaco+Trab. POAG and PACG were present in 71 and 75 eyes, respectively. Defining a failure with IOP criteria of >18 mm Hg or IOP reduction of <30%, the failure rates were 42% and 62% for Phaco+Trab and Trab, respectively. The Phaco+Trab group had a significantly lower failure rate than the Trab group for all subjects [risk ratio (RR): 0.60, 95% CI, 0.44-0.81, P =0.001], POAG subgroup (RR: 0.61, 95% CI, 0.41-0.93, P =0.02), and PACG subgroup (RR: 0.53, 95% CI, 0.33-0.86, P =0.01). Differences in the postoperative IOP, percentage of IOP reduction, and number of glaucoma medications were not significant between the 2 groups for all subjects, POAG, and PACG (all P >0.05). The magnitude of the effects of adding phacoemulsification to the trabeculectomy was comparable for the POAG and PACG groups, for each outcome (all P >0.05).
The final 24-month failure rate in the Phaco+Trab group was lower than that in the Trab group in both the POAG and PACG subjects. The impact of adding phacoemulsification to trabeculectomy was found to be similar between the eyes with POAG and PACG.
在原发性开角型青光眼（POAG）和原发性闭角型青光眼（PACG）患者中，超声乳化小梁切除术的24个月失败率显著低于单纯小梁切除术。在POAG和PACG眼中，小梁切除术联合超声乳化的效果相似。
本研究旨在比较原发性丝裂霉素C强化的超声乳化小梁切除术（超声乳化+小梁切除术）与单纯小梁切除术（小梁切除术）在患有POAG和PACG的有晶状体眼患者中的2年疗效。
我们回顾性分析了接受丝裂霉素C强化小梁切除术并完成2年随访的原发性青光眼患者。比较了超声乳化+小梁切除术组和小梁切除术组术后24个月的失败率、眼压（IOP）、眼压降低百分比以及青光眼药物使用数量。
该研究纳入了121例患者的146只眼；74只眼接受了小梁切除术，72只眼接受了超声乳化+小梁切除术。POAG和PACG分别存在于71只眼和75只眼中。以眼压>18 mmHg或眼压降低<30%作为失败标准，超声乳化+小梁切除术组和小梁切除术组的失败率分别为42%和62%。对于所有受试者[风险比（RR）：0.60，95%置信区间（CI），0.44 - 0.81，P = 0.001]、POAG亚组（RR：0.61，95% CI，0.41 - 0.93，P = 0.02）和PACG亚组（RR：0.53，95% CI，0.33 - 0.86，P = 0.01），超声乳化+小梁切除术组的失败率显著低于小梁切除术组。两组在所有受试者、POAG和PACG中的术后眼压、眼压降低百分比以及青光眼药物使用数量的差异均无统计学意义（所有P>0.05）。对于每个结局，在POAG组和PACG组中，小梁切除术联合超声乳化的效果大小相当（所有P>0.05）。
在POAG和PACG受试者中，超声乳化+小梁切除术组的最终24个月失败率均低于小梁切除术组。在POAG和PACG眼中，小梁切除术联合超声乳化的效果相似。
