Qin Zuo-Xin, Ying Xi, Han Qing, Wang Lu, Tan Lian, Xu Yu-Fei, You Qiu-Xiang, Wu Nan, Liu Yong
Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.
Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China.
Int J Ophthalmol. 2023 Mar 18;16(3):367-374. doi: 10.18240/ijo.2023.03.06. eCollection 2023.
To evaluate the outcomes and elucidate the failure factors for trabeculectomy with mitomycin C (MMC) in Southwest Chinese patients.
A retrospective correlational study was conducted on the glaucomatous patients who underwent initial trabeculectomy with MMC in Southwest Hospital and had been followed up for 1-3y. A complete success for surgery is defined as a postoperative intraocular pressure (IOP) >5 and ≤21 mm Hg and 20% reduction of IOP compared to preoperative, without IOP-lowering medications. A qualified success for surgery is defined as the abovementioned postoperative IOP with or without IOP-lowering medications. The primary outcomes were IOP, the number of IOP-lowering medications, and cumulative success rate. The secondary outcomes included best corrected visual acuity (BCVA), mean deviation (MD) of visual field, major complications, and risk factors for surgical failure.
A total of 325 eyes of 261 glaucomatous patients had been included in our study. Both the mean IOP and the number of IOP-lowering medications were significantly decreased from 32.9±12.0 to 16.4±5.7 mm Hg (<0.0001) and 3.0±0.9 to 0.9±1.0 (<0.0001), respectively, at the last visit. The cumulative complete success rate and qualified success rate were 77.8% and 92.0% at 1-year follow-up, and 47.2% and 77.7% at 3-year follow up. There were no significant differences in surgical outcomes between primary angle-closure glaucoma (PACG) and primary open angle glaucoma (POAG). In PACG patients, the success rates of trabeculectomy were comparable with those of phacotrabeculectomy. Hypertension (HR=1.904, =0.011), encapsulated bleb (HR=2.756, <0.001), and more preoperative topical medications (HR=2.475, =0.008) were risk factors for surgical failure.
The qualified success rate of trabeculectomy with MMC in glaucomatous patients in the cohort is 92.0% at 1-year, and 77.7% at 3-year follow up. Hypertension, encapsulated bleb, and more preoperative topical medications are associated with surgical failure.
评估中国西南地区青光眼患者行丝裂霉素C（MMC）小梁切除术的效果并阐明失败因素。
对在西南医院接受初次MMC小梁切除术并随访1 - 3年的青光眼患者进行回顾性相关性研究。手术完全成功定义为术后眼压（IOP）>5且≤21 mmHg，与术前相比眼压降低20%，且无需使用降眼压药物。手术合格成功定义为上述术后眼压情况，无论是否使用降眼压药物。主要观察指标为眼压、降眼压药物使用数量及累积成功率。次要观察指标包括最佳矫正视力（BCVA）、视野平均缺损（MD）、主要并发症及手术失败的危险因素。
本研究共纳入261例青光眼患者的325只眼。末次随访时，平均眼压和降眼压药物使用数量分别从32.9±12.0显著降至16.4±5.7 mmHg（<0.0001）和从3.0±0.9降至0.9±1.0（<0.0001）。1年随访时累积完全成功率和合格成功率分别为77.8%和92.0%，3年随访时分别为47.2%和77.7%。原发性闭角型青光眼（PACG）和原发性开角型青光眼（POAG）的手术效果无显著差异。在PACG患者中，小梁切除术的成功率与晶状体小梁切除术相当。高血压（HR = 1.904，P = 0.011）、包裹性滤过泡（HR = 2.756，<0.001）及术前更多局部用药（HR = 2.475，P = 0.008）是手术失败的危险因素。
该队列中青光眼患者行MMC小梁切除术的合格成功率1年时为92.0%，3年时为77.7%。高血压、包裹性滤过泡及术前更多局部用药与手术失败相关。
