Ayyala R S, Pieroth L, Vinals A F, Goldstein M H, Schuman J S, Netland P A, Dreyer E B, Cooper M L, Mattox C, Frangie J P, Wu H K, Zurakowski D
University Eye Associates, Boston University Medical Center, Massachusetts, USA.
Ophthalmology. 1998 Aug;105(8):1550-6. doi: 10.1016/S0161-6420(98)98046-0.
This study aimed to compare the surgical outcomes of mitomycin C trabeculectomy glaucoma drainage device (GDD) surgery and laser neodymium:YAG (Nd:YAG) cyclophotocoagulation (CPC) in the management of intractable glaucoma after penetrating keratoplasty (PKP) in a retrospective study.
Interventional case series.
PARTICIPANTS/METHODS: The medical charts of consecutive patients who had pre-existing glaucoma or who developed glaucoma after PKP and underwent a surgical procedure to control the glaucoma at the University Eye Associates of Boston University Medical Center, New England Eye Center, and Massachusetts Eye and Ear Infirmary between January 1991 and July 1995 were reviewed. Follow-up ranged from 6 months to 4 years after the glaucoma procedure. A total of 38 patients were included consisting of 17 patients who underwent mitomycin C, 10 patients who underwent GDD surgery, and 11 patients who had CPC.
Mitomycin C trabeculectomy, GDDs, or Nd:YAG CPC to control glaucoma after PKP was performed,
Graft status, postoperative intraocular pressure (IOP), and visual acuity were the main outcome measures.
There were no differences among the three groups with respect to the follow-up time after the corneal graft operation (P = 0.15) or after the glaucoma operation (P = 0.98). At the final follow-up, the average decrease in the IOP was 17 mmHg (P < 0.001) after mitomycin C, 15 mmHg (P = 0.003) after GDD surgery, and 14.4 mmHg (P = 0.001) after CPC. There were no differences in the proportion of patients who developed postoperative IOP above 20 mmHg (P = 0.50) and in the proportion who developed hypotony (P = 0.10) among the three groups. Two grafts failed after mitomycin C and one failed after CPC. Among the three procedures, there were no differences in the proportion of patients who experienced either an improvement (P = 0.14) or a decrease (P = 0.22) in the visual acuity by more than one line after the glaucoma procedure. One patient each in the GDD group and the CPC group lost light perception after the procedure. The risk of graft failure was almost three times higher for each additional PKP (odds ratio = 2.80, P = 0.02).
No differences were found among the three glaucoma procedures with respect to controlling IOP and graft failure. There was a trend for patients treated with CPC to have a higher incidence of graft failure, glaucoma failure, hypotony, and visual loss by more than one line, although this was not statistically significant. The number of PKPs was associated with graft failure, independent of the surgical procedure.
本回顾性研究旨在比较丝裂霉素C小梁切除术、青光眼引流装置（GDD）手术和激光钕：钇铝石榴石（Nd：YAG）睫状体光凝术（CPC）在穿透性角膜移植术（PKP）后难治性青光眼治疗中的手术效果。
干预性病例系列研究。
参与者/方法：回顾了1991年1月至1995年7月期间在波士顿大学医学中心大学眼科协会、新英格兰眼中心和马萨诸塞州眼耳医院接受手术以控制已有青光眼或PKP后发生青光眼的连续患者的病历。青光眼手术后随访时间为6个月至4年。共纳入38例患者，其中17例行丝裂霉素C治疗，10例行GDD手术，11例行CPC。
进行丝裂霉素C小梁切除术、GDD植入或Nd：YAG CPC以控制PKP后的青光眼。
移植状态、术后眼压（IOP）和视力是主要观察指标。
三组在角膜移植术后（P = 0.15）或青光眼手术后（P = 0.98）的随访时间方面无差异。在最后一次随访时，丝裂霉素C治疗后眼压平均降低17 mmHg（P < 0.001），GDD手术后降低15 mmHg（P = 0.003），CPC后降低14.4 mmHg（P = 0.001）。三组中术后眼压高于20 mmHg的患者比例（P = 0.50）和发生低眼压的患者比例（P = 0.10）无差异。丝裂霉素C治疗后有2例移植失败，CPC后有1例失败。在三种手术中，青光眼手术后视力提高（P = 0.14）或降低（P = 0.22）超过一行的患者比例无差异。GDD组和CPC组各有1例患者术后失去光感。每增加一次PKP，移植失败的风险几乎高出三倍（优势比 = 2.80，P = 0.02）。
三种青光眼手术在控制眼压和移植失败方面未发现差异。CPC治疗的患者有移植失败、青光眼治疗失败、低眼压和视力下降超过一行的发生率较高的趋势，尽管这在统计学上无显著意义。PKP的次数与移植失败相关，与手术方式无关。
