Vesti E, Raitta C
Department of Ophthalmology, Helsinki University Central Hospital, Finland.
Ophthalmic Surg Lasers. 1997 Feb;28(2):128-32.
The outcome of trabeculectomy in the treatment of primary open-angle glaucoma and exfoliative glaucoma was reviewed.
The study included 87 consecutive eyes of 87 patients with open-angle glaucoma. The outcome of trabeculectomy was correlated with a biomicroscopic appearance of the filtering bleb. Visual acuity, myopic shift in refraction, and lens opacity measurements were used as indicators for cataract progression. The effect of viscoelastics on complications and short-term outcome was studied in a randomized series of 107 eyes.
In a series of 87 eyes, 61% had intraocular pressure (IOP) of less than 22 mm Hg without glaucoma medication 1 year after surgery. After 3 years, the corresponding success rate was 74% in a series of 85 eyes that had preoperative pupillary dilation of 4 mm or more.
The diffuse filtering bleb type was associated with the greatest decrease in IOP. Unfavorable flap-sized blebs and bleb failures were associated with preoperative treatment with miotics, anterior fistulation, and postoperative hypotony. These patients also tended to be younger. In a randomized, prospective study of 107 eyes, the use of sodium hyaluronate had no significant effect on the incidence of complications or on the short-term outcome. Age 61 years or older, exfoliative glaucoma, postoperative hypotony, and IOP peaks were identified as risk factors for accelerated cataract progression after trabeculectomy.
回顾小梁切除术治疗原发性开角型青光眼和剥脱性青光眼的疗效。
该研究纳入了87例开角型青光眼患者的87只连续眼。小梁切除术的疗效与滤过泡的生物显微镜外观相关。视力、屈光近视偏移和晶状体混浊测量用作白内障进展的指标。在107只眼的随机系列中研究了粘弹剂对并发症和短期疗效的影响。
在87只眼中，61%的患者术后1年未使用青光眼药物时眼压（IOP）低于22 mmHg。3年后，在术前瞳孔散大4 mm或更大的85只眼中，相应的成功率为74%。
弥漫性滤过泡类型与眼压下降最大相关。不良瓣大小的滤过泡和滤过泡失败与术前使用缩瞳剂治疗、前房造瘘和术后低眼压有关。这些患者往往更年轻。在对107只眼的随机前瞻性研究中，透明质酸钠的使用对并发症发生率或短期疗效无显著影响。61岁或以上、剥脱性青光眼、术后低眼压和眼压峰值被确定为小梁切除术后白内障加速进展的危险因素。
