Tanihara H, Honjo M, Inatani M, Honda Y, Ogino N, Ueno S, Negi A, Ichioka H, Mizoguchi T, Matsumura M, Nagata M
Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Japan.
Ophthalmic Surg Lasers. 1997 Oct;28(10):810-7.
The authors previously reported the usefulness of trabeculotomy ab externo for the treatment of primary open-angle glaucoma in adult patients. In an attempt to elucidate the long-term risk-to-benefit ratio of this surgical modality in combination with cataract surgery, the authors conducted a retrospective study of the surgical effects and complications of a triple procedure: phacoemulsification, implantation (of an intraocular lens), and trabeculotomy (PIT).
The authors conducted a retrospective study of patients treated with PIT at multiple hospitals. Intraocular pressure (IOP) and visual function data were obtained from patients after PIT as an initial surgical treatment in cases where antiglaucoma medications failed to resolve uncontrolled IOP (higher than 21 mm Hg). Included in this study were 96 eyes of 64 patients with primary open-angle glaucoma and coexisting cataract. The mean follow-up period was 22.6 +/- 14.7 months (range 3-56 months).
In 94 (98%) of the 96 eyes, the IOP was well controlled, having achieved a level of 21 mm Hg or lower at the final examinations. The mean preoperative IOP of the 33 eyes that underwent the triple procedure using a single flap method (PIT-I) was 24.3 +/- 3.9 mm Hg, with an average of 2.1 +/- 1.1 medications. At the final examinations, the mean IOP had dropped to 16.0 +/- 1.2 mm Hg, with an average of 1.2 +/- 1.2 medications. The mean preoperative IOP of the 63 eyes that underwent the triple procedure using a double flap method (PIT-II) was 26.2 +/- 6.2 mm Hg, with an average of 1.9 +/- 1.2 medications. At the final examination, the mean IOP for this group was 15.6 +/- 2.9 mm Hg, with an average of 1.0 +/- 0.9 medications.
The long-term results from this multicenter study showed that the triple procedure, PIT, can be useful and effective as an initial surgical treatment for open-angle glaucoma in glaucoma patients with coexisting cataract.
作者此前报道了外路小梁切开术治疗成年原发性开角型青光眼的有效性。为了阐明这种手术方式与白内障手术联合应用的长期风险效益比，作者对一种三联手术（超声乳化白内障吸除术、人工晶状体植入术和小梁切开术，即PIT）的手术效果和并发症进行了回顾性研究。
作者对多家医院接受PIT治疗的患者进行了回顾性研究。对于抗青光眼药物治疗后眼压仍无法控制（高于21 mmHg）的患者，将PIT作为初始手术治疗，收集患者术后的眼压和视功能数据。本研究纳入了64例原发性开角型青光眼合并白内障患者的96只眼。平均随访时间为22.6±14.7个月（范围3 - 56个月）。
96只眼中有94只（98%）眼压得到良好控制，在最后一次检查时眼压达到或低于21 mmHg。采用单瓣法进行三联手术（PIT - I）的33只眼术前平均眼压为24.3±3.9 mmHg，平均使用2.1±1.1种药物。在最后一次检查时，平均眼压降至16.0±1.2 mmHg，平均使用1.2±1.2种药物。采用双瓣法进行三联手术（PIT - II）的63只眼术前平均眼压为26.2±6.2 mmHg，平均使用1.9±1.2种药物。在最后一次检查时，该组平均眼压为15.6±2.9 mmHg，平均使用1.0±0.9种药物。
这项多中心研究的长期结果表明，三联手术PIT作为合并白内障的青光眼患者开角型青光眼的初始手术治疗方法可能是有用且有效的。
