Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Graduate Medical School, Singapore.
Singapore Eye Research Institute, Singapore.
Asia Pac J Ophthalmol (Phila). 2024 Sep-Oct;13(5):100102. doi: 10.1016/j.apjo.2024.100102. Epub 2024 Sep 28.
To describe the long-term outcomes of phacotrabeculectomy from a tertiary glaucoma service in Singapore.
Retrospective case series.
Seven hundred ninety-six eyes of 698 patients who underwent phacotrabeculectomy surgery at the Singapore National Eye Centre between 2005 and 2007 with a minimum follow-up of three years were included. The primary outcome measure was intraocular pressure (IOP). Secondary outcomes included best-corrected visual acuity (BCVA), number of glaucoma medications, and surgical complications.
The mean age was 69.5 years, 51 % were male, and 86 % were Chinese. Most eyes had primary glaucoma (90.6 %). The mean follow-up duration was 9.4 years. The overall success rate at three years was 97 % if surgical success was defined as IOP ≤ 21 mm Hg, 92 % if IOP ≤ 18 mm Hg, 66 % if IOP ≤ 15 mm Hg. By Kaplan-Meier survival analysis over 13 years, the cumulative success rate fell from 98.1 % to 89.1 % if IOP ≤ 21 mm Hg, 98.1-76.9 % if IOP ≤ 18 mm Hg, 98-50.3 % if IOP ≤ 15 mm Hg. The postoperative IOP improved significantly at all time points (P < 0.05) and 72 % had at least 20 % IOP reduction. There was a slight improvement in postoperative BCVA (P < 0.05). The mean number of glaucoma medications was reduced postoperatively (P < 0.001). There were no significant risk factors for surgical failure.
Phacotrabeculectomy was found to be safe, resulting in clinically significant IOP lowering for 13 years with reduced dependency on glaucoma medications and improved BCVA.
描述新加坡一家三级青光眼服务机构行超声乳化白内障吸除联合小梁切除术的长期结果。
回顾性病例系列。
纳入了 2005 年至 2007 年期间在新加坡国家眼科中心接受超声乳化白内障吸除联合小梁切除术的 698 例 796 只眼患者，这些患者的随访时间至少为 3 年。主要结局测量指标为眼压（IOP）。次要结局包括最佳矫正视力（BCVA）、降眼压药物使用数量和手术并发症。
平均年龄为 69.5 岁，51%为男性，86%为华人。大多数患者患有原发性青光眼（90.6%）。平均随访时间为 9.4 年。如果将手术成功定义为 IOP≤21mmHg，则 3 年时的总体成功率为 97%；如果将手术成功定义为 IOP≤18mmHg，则总体成功率为 92%；如果将手术成功定义为 IOP≤15mmHg，则总体成功率为 66%。通过 Kaplan-Meier 生存分析，在 13 年的随访中，如果将 IOP≤21mmHg，则累积成功率从 98.1%降至 89.1%；如果将 IOP≤18mmHg，则累积成功率从 98.1%降至 76.9%；如果将 IOP≤15mmHg，则累积成功率从 98%降至 50.3%。术后各时间点的眼压均显著改善（P<0.05），72%的患者眼压降低至少 20%。术后 BCVA 略有改善（P<0.05）。术后降眼压药物的使用数量减少（P<0.001）。手术失败无明显危险因素。
超声乳化白内障吸除联合小梁切除术安全有效，可显著降低眼压，持续 13 年，减少对降眼压药物的依赖，提高 BCVA。
