Hill R A, Nguyen Q H, Baerveldt G, Forster D J, Minckler D S, Rao N, Lee M, Heuer D K
Department of Ophthalmology, University of California, Irvine College of Medicine 92717.
Ophthalmology. 1993 Jun;100(6):903-8. doi: 10.1016/s0161-6420(93)31556-3.
This study compares the outcomes of trabeculectomy and Molteno implantation in the treatment of glaucomas associated with uveitis.
Forty-five patients with uveitis, who had undergone filtering surgery for glaucomas associated with uveitis, were reviewed retrospectively. Successful outcome was defined as final intraocular pressure (IOP) of 6 to 21 mmHg, with a minimum follow-up of 6 months without visually devastating complications or loss of light perception.
One- and two-year life-table success rates, respectively, were 81% and 73% with trabeculectomy (16 patients); 53% and 31% with combined trabeculectomy and first-stage (reserve) Molteno implantation (19 patients); and 79% and 79% with one-stage Molteno implantation (10 patients). In 11 patients who underwent second-stage Molteno implantation after trabeculectomy failure, 1- and 2-year life-table success rates were 79% and 79%, respectively. Complications included surgically treated choroidal effusions (1/45; 2%), choroidal hemorrhages (3/45; 7%), and chronic hypotony (3/45; 7%). Follow-up in all groups ranged from 5 to 70 months (mean +/- standard deviation, 28 +/- 17 months).
Trabeculectomy provides surprisingly good results in glaucomas associated with uveitis (modulation of wound healing with antimetabolites probably would afford an even higher success rate). However, when significant, immediate postoperative and/or moderate chronic postoperative inflammation is likely, aqueous drainage devices appear more likely to control IOP.
本研究比较小梁切除术和莫尔顿植入术治疗葡萄膜炎相关性青光眼的效果。
回顾性分析45例因葡萄膜炎相关性青光眼接受滤过手术的患者。成功结局定义为最终眼压为6至21 mmHg，至少随访6个月且无严重视力损害并发症或光感丧失。
小梁切除术（16例患者）的1年和2年生命表成功率分别为81%和73%；小梁切除术联合一期（备用）莫尔顿植入术（19例患者）的成功率分别为53%和31%；一期莫尔顿植入术（10例患者）的成功率分别为79%和79%。在小梁切除术失败后接受二期莫尔顿植入术的11例患者中，1年和2年生命表成功率分别为79%和79%。并发症包括手术治疗的脉络膜渗漏（1/45；2%）、脉络膜出血（3/45；7%）和慢性低眼压（3/45；7%）。所有组的随访时间为5至70个月（平均±标准差，28±17个月）。
小梁切除术治疗葡萄膜炎相关性青光眼的效果出人意料地好（使用抗代谢药物调节伤口愈合可能会获得更高的成功率）。然而，当术后即刻有明显炎症和/或术后有中度慢性炎症时，房水引流装置似乎更有可能控制眼压。
