Tanihara H, Negi A, Akimoto M, Nagata M
Section of Ophthalmology, Tenri Hospital, Japan.
Ophthalmic Surg. 1995 Jul-Aug;26(4):316-24.
Trabeculotomy ab externo has been demonstrated to be effective in controlling intraocular pressure (IOP) in adult patients with either primary open-angle glaucoma or pseudoexfoliation syndrome. We evaluated the surgical outcome of 60 eyes with either primary open-angle glaucoma or pseudoexfoliation syndrome that underwent combined trabeculotomy ab externo and cataract extraction. All patients were at least 40 years old, and were followed for at least 1 year. At the final examination, IOP was well controlled (21 mm Hg or less) in 54 (90%) of the 60 eyes, with or without medication. Also, "overall success" (ie, stabilization of IOP, visual field, and optic nerve status) was achieved in 49 (81.7%). Complications included fibrin exudation (22%), transient IOP elevation (17%), early perforation of the probe into the anterior chamber (10%), and detachment of Descemet's membrane (5%). We recommend combined trabeculotomy ab externo and cataract extraction in selected cases of glaucoma with coexisting cataract. For cases in which the target IOP level is in the low teens, or for patients who may not tolerate postoperative fluctuations in IOP, we do not recommend trabeculotomy ab externo. Also, in eyes that have normal-tension glaucoma, or that have already sustained severe damage to the optic nerve, visual dysfunction caused by glaucomatous changes may progress even after successful combined trabeculotomy ab externo and cataract extraction.
外路小梁切开术已被证明在控制原发性开角型青光眼或假性剥脱综合征成年患者的眼压方面有效。我们评估了60例接受外路小梁切开术联合白内障摘除术的原发性开角型青光眼或假性剥脱综合征患者的手术效果。所有患者年龄至少40岁，且随访至少1年。在最后一次检查时，60眼中有54眼（90%）的眼压得到良好控制（21 mmHg或更低），无论是否使用药物。此外，49眼（81.7%）实现了“总体成功”（即眼压、视野和视神经状态稳定）。并发症包括纤维蛋白渗出（22%）、短暂性眼压升高（17%）、探头早期穿入前房（10%）和后弹力层脱离（5%）。对于合并白内障的青光眼患者，我们建议在特定病例中采用外路小梁切开术联合白内障摘除术。对于目标眼压水平在十几mmHg低水平的病例，或对于可能无法耐受术后眼压波动的患者，我们不建议采用外路小梁切开术。此外，在正常眼压性青光眼患者或已经对视神经造成严重损害的眼中，即使外路小梁切开术联合白内障摘除术成功，青光眼性改变引起的视觉功能障碍仍可能进展。
