Koller T L, Stürmer J, Gloor B
Augenklinik des Universitätsspitales Zürich.
Klin Monbl Augenheilkd. 1998 Jul;213(1):1-8. doi: 10.1055/s-2008-1034936.
Trabeculectomy is today the filtering procedure of choice, because complications are rare and success-rates high. A modification of our technique (fornix-based conjunctival flap closed by a running suture) introduced 3 years ago, has lead us to this retrospective assessment of complications and success-rates. Some of the risk factors for failure are known, others however remain obscure. This retrospective series was also used to further identify some of these risk factors for trabeculectomy failure.
All 388 trabeculectomies performed between January 1992 and June 1994 at our hospital were included in the study. Important pre- and postoperative data were retrospectively assessed from patients case notes, with a special interest in the course of post-operative intra-ocular pressure (IOP). Two major groups were differentiated: Those with open-angle glaucoma (OAG) (i.e. primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX) and pigment dispersion syndrome (PDS)), and other various glaucoma diagnoses. Risk factors were assessed using Cox-proportional hazard model adopting three different criteria for success.
The best success-rate after 12 months of follow-up had patients with narrow angle glaucoma (93.1%)(at least those suitable for filtering surgery), followed by patients with POAG (92.8%), 2 degrees open-angle glaucoma (81.8%), aphakic (75%), juvenile (70.6%) and PDS (52.9%). Pseudophakia and development of an encapsulated bleb (Tenon' cyst) were identified as significant (p < 0.05) risk factors for failure. In addition, YAG-Laser Iridotomy in OAG-group and Aphakia in the group of various glaucoma diagnoses were identified as risk factors for successful post-operative IOP control.
Filtering surgery (trabeculectomy) is a potent method to reduce IOP. Pseudophakia and an encapsulated bleb are the main risk factors for surgical failure. Because of amazingly high success-rates we tend to perform filtering surgery today earlier than ten years ago, especially as previous long-term topical antiglaucoma treatment may reduce filtering surgery success.
小梁切除术是目前首选的滤过手术，因为并发症少见且成功率高。3年前我们引入了一种改良技术（采用连续缝合关闭穹窿部结膜瓣），促使我们对并发症和成功率进行了此次回顾性评估。一些导致手术失败的风险因素已为人所知，但其他一些因素仍不清楚。这个回顾性系列研究还用于进一步确定小梁切除术失败的一些风险因素。
本研究纳入了1992年1月至1994年6月在我院进行的所有388例小梁切除术。从患者病历中回顾性评估重要的术前和术后数据，特别关注术后眼压（IOP）的变化过程。分为两大组：开角型青光眼（OAG）组（即原发性开角型青光眼（POAG）、剥脱性青光眼（PEX）和色素性青光眼综合征（PDS）），以及其他各种青光眼诊断组。采用Cox比例风险模型，根据三种不同的成功标准评估风险因素。
随访12个月后，窄角型青光眼患者的成功率最高（93.1%）（至少是那些适合滤过手术的患者），其次是POAG患者（92.8%）、2级开角型青光眼患者（81.8%）、无晶状体眼患者（75%）、青少年患者（70.6%）和PDS患者（52.9%）。人工晶状体植入和包裹性滤泡（Tenon囊肿）的形成被确定为导致手术失败的显著（p<0.05）风险因素。此外，OAG组的YAG激光虹膜切开术和各种青光眼诊断组的无晶状体眼被确定为术后眼压成功控制的风险因素。
滤过手术（小梁切除术）是降低眼压的有效方法。人工晶状体植入和包裹性滤泡是手术失败的主要风险因素。由于成功率惊人地高，我们现在倾向于比十年前更早地进行滤过手术，特别是因为之前长期的局部抗青光眼治疗可能会降低滤过手术的成功率。
