背景:为了比较超声乳化联合Ex-PRESS植入(Phaco-ExPRESS)的气泡形态,超声乳化小梁切除术(Phaco-Trab),术后2年小梁切除术(Trab)。
方法:本研究包括患有或不患有白内障的原发性开角型青光眼(POAG)患者。所有患者都接受了Phaco-ExPRESS的手术,Phaco-Trab,或陷阱。过滤泡的形态结构,包括微囊区,超反射点密度,和体内共聚焦显微镜(IVCM)下的基质结缔组织,比较三组之间的差异。术前、术后2周收集数据,1个月,3个月,6个月,12个月,18个月,还有24个月.
结果:纳入89例患者的89只眼,包括Phaco-ExPRESS组的32人,在Phaco-Trab组中有25名,在Trab组中为32。在24个月的随访中,Phaco-ExPRESS中的气泡形态与Trab组相似。Phaco-ExPRESS和Trab组的上皮微囊肿面积显着增加,而Phaco-Trab组的上皮微囊肿面积显着减少。术后24个月,Phaco-ExPRESS的完全成功率为65.1%,在Phaco-Trab中占32.0%,Trab组为59.4%(P=0.03)。phaco-Trab组术后抗青光眼药物较其他两组多(P<0.05)。
结论:Phaco-ExPRESS组和Trab组在IVCM中具有相似的气泡形态,微囊肿面积较大,疏松的结缔组织,炎症比Phaco-Trab少,表明Phaco-ExPRESS和Trab组中气泡的功能,比Phaco-Trab更有效。所有这些手术方法都提供了足够的眼压控制,但是Phaco-Trab需要更多的抗青光眼药物。
BACKGROUND: To compare the bleb morphologies of phacoemulsification combined with Ex-PRESS implantation (Phaco-ExPRESS), phaco trabeculectomy (Phaco-Trab), and trabeculectomy (Trab) in postoperative two years.
METHODS: Patients with primary open-angle glaucoma (POAG) with or without cataracts were included in this study. All patients underwent surgeries of either Phaco-ExPRESS, Phaco-Trab, or Trab. The morphologic structures of the filtering bleb, including microcysts area, hyperreflective dot density, and stromal connective tissue under in vivo confocal microscope (IVCM), were compared between the three groups. The data were collected preoperatively and postoperatively at 2 weeks, 1 month, 3 months, 6 months, 12 months, 18 months, and 24 months.
RESULTS: Eighty-nine eyes from 89 patients were enrolled, including 32 in the Phaco-ExPRESS group, 25 in the Phaco-Trab group, and 32 in the Trab group. In a 24-month follow-up, bleb morphologies in Phaco-ExPRESS were similar to the Trab group. The area of epithelial microcysts was significantly increased in Phaco-ExPRESS and Trab groups while significantly decreased in Phaco-Trab. At postoperative 24 months, the complete success rate was 65.1% in Phaco-ExPRESS, 32.0% in Phaco-Trab, and 59.4% in the Trab group (P = 0.03). The phaco-Trab group had more postoperative anti-glaucoma medications than the other two groups (P < 0.05).
CONCLUSIONS: Phaco-ExPRESS group and Trab group had similar blebs morphologies in IVCM, with larger microcyst area, looser connective tissue, and less inflammation than Phaco-Trab, indicating that the function of blebs in the Phaco-ExPRESS and Trab group, was more potent than that of Phaco-Trab. All these surgical methods provided adequate IOP control, but Phaco-Trab required more anti-glaucoma medications.