Broadway D C, Grierson I, O'Brien C, Hitchings R A
Moorfields Eye Hospital, London, England.
Arch Ophthalmol. 1994 Nov;112(11):1446-54. doi: 10.1001/archopht.1994.01090230060021.
To determine the effect of long-term topical antiglaucoma therapy on the results of glaucoma filtration surgery and to relate any differences to the cell population profile of the conjunctiva.
Filtration surgery was performed in 124 patients (trabeculectomy in 112 and triple procedures [trabeculectomy, cataract extraction, and intraocular lens implantation] in 12), and the outcome of these procedures was assessed after a minimum follow-up of 6 months. A conjunctival biopsy specimen was obtained at the time of surgery. The patients were divided into four groups according to the type of topical therapy administered. The duration of therapy tended to be greater for the patients treated with a greater number of medication types. The outcome of trabeculectomy was assessed in 106 of the patients.
In comparison with the briefly treated-primary surgery group, the success rate of trabeculectomy (90% [n = 28]) was similar to that in the group treated with beta-blockers (93% [n = 29]). The trabeculectomy success rate for patients treated with beta-blockers and miotics was significantly lower (72%, P < .01 [n = 29]), and that for the group treated with beta-blockers, miotics, and sympathomimetics was even lower (45%, P < .001, [n = 20]).
Various treatment regimens were associated with differential effects on the success rate of trabeculectomy. Long-term topical combination therapy was identified as a significant risk factor for failure of trabeculectomy. Preoperative conjunctival cell counts from patients whose trabeculectomies were successful were compared with those whose trabeculectomies failed. Failure was associated with significantly more pale cells (P < .01), macrophages (P < .05), and lymphocytes (P < .05) in the epithelium; fibroblasts (P < .05) and macrophages (P < .05) in the superficial substantia propria; and both macrophages and lymphocytes in the deep substantia propria (P < .01). Thus, preoperative subclinical conjunctival inflammation induced by previous topical medication was identified as a risk factor for failure of trabeculectomy.
确定长期局部抗青光眼治疗对青光眼滤过手术结果的影响，并将任何差异与结膜的细胞群体特征相关联。
对124例患者进行了滤过手术（112例行小梁切除术，12例行三联手术[小梁切除术、白内障摘除术和人工晶状体植入术]），并在至少随访6个月后评估这些手术的结果。手术时获取结膜活检标本。根据局部治疗的类型将患者分为四组。用药种类越多的患者，治疗持续时间往往越长。对106例患者的小梁切除术结果进行了评估。
与短期治疗-初次手术组相比，小梁切除术的成功率（90%[n = 28]）与β受体阻滞剂治疗组（93%[n = 29]）相似。接受β受体阻滞剂和缩瞳剂治疗的患者小梁切除术成功率显著较低（72%，P <.01[n = 29]），而接受β受体阻滞剂、缩瞳剂和拟交感神经药治疗组的成功率更低（45%，P <.001，[n = 20]）。
不同的治疗方案对小梁切除术成功率有不同影响。长期局部联合治疗被确定为小梁切除术失败的一个重要危险因素。将小梁切除术成功患者的术前结膜细胞计数与失败患者的进行比较。小梁切除术失败与上皮中显著更多的苍白细胞（P <.01）、巨噬细胞（P <.05）和淋巴细胞（P <.05）；浅固有层中的成纤维细胞（P <.05）和巨噬细胞（P <.05）；以及深固有层中的巨噬细胞和淋巴细胞（P <.01）有关。因此，先前局部用药引起的术前亚临床结膜炎症被确定为小梁切除术失败的一个危险因素。
