背景:这项研究旨在评估连续五年对青光眼患者进行超声乳化-内膜光凝(phaco-ECP)的有效性和安全性。
方法:对38例原发性和继发性青光眼患者(38只眼)进行超声乳化超声乳化术(EndoOptiksURAME2,Beaver-VisitecInternational,沃尔瑟姆,MA,美国)。主要结果指标是眼内压(IOP)降低,成功率,青光眼药物使用,超声乳化ECP后的视力。与基线值相比没有再干预的IOP降低20%被认为是成功的治疗。完全成功被定义为停止抗青光眼药物。次要结果指标包括术中和术后并发症。术前和术后第一周以及术后1、3、6、12、18、24、30、36、42、48、54和60个月进行测量。
结果:术前IOP的平均值±SD值,术后12、24、36、48和60个月分别为22.6±6.7mmHg,15.9±3.9mmHg(p<0.001),15.9±2.9mmHg(p<0.001),15.6±2.7mmHg(p<0.001),15.5±3.8mmHg(p<0.001),15.2±2.6mmHg(p<0.001),分别。末次随访时平均眼压降低32.7%。与基线相比,每次随访时,抗青光眼药物数量的减少具有统计学意义。合格率为40.6%。在60个月的随访中,所有患者都需要使用抗青光眼药物-没有患者获得完全成功。在后续期间,9例(28.3%)因未达到目标IOP而需要再治疗的患者被认为失败.6名患者(15.8%)从随访中消失。共有23例患者在他们的phaco-ECP后60个月进行了评估。与手术直接相关的并发症,如角膜水肿(25.6%),IOP峰值(20.5%),人工晶状体脱位(2.6%),和葡萄膜炎(12.8%),在我们的患者中观察到。在我们的任何患者中均未观察到低张力。
结论:phaco-ECP程序有效,耐受性良好,并且在长期随访中可以安全地降低患有白内障的青光眼患者的IOP。随机化,需要更大规模的研究来验证获得的结果。
BACKGROUND: this study aimed to assess the effectiveness and safety of phaco-endocyclophotocoagulation (phaco-ECP) in patients with glaucoma over five consecutive years.
METHODS: Thirty-eight patients (38 eyes) with primary and secondary glaucoma were enrolled to undergo phaco-ECP (Endo Optiks URAM E2, Beaver-Visitec International, Waltham, MA, USA). The primary outcome measures were intraocular pressure (IOP) reduction, success rates, glaucoma medication use, and visual acuity after phaco-ECP. An IOP reduction of 20% compared to the baseline value without re-intervention was considered a successful treatment. Complete success was defined as a cessation of antiglaucoma medications. Secondary outcome measures included intraoperative and postoperative complications. Measurements were performed preoperatively and in the first week and 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months postoperatively.
RESULTS: The mean ± SD values of IOP preoperatively, at 12, 24, 36, 48, and 60 months postoperatively were 22.6 ± 6.7 mmHg, 15.9 ± 3.9 mmHg (p < 0.001), 15.9 ± 2.9 mmHg (p < 0.001), 15.6 ± 2.7 mmHg (p < 0.001), 15.5 ± 3.8 mmHg (p < 0.001), and 15.2 ± 2.6 mmHg (p < 0.001), respectively. The mean IOP at the last follow-up was reduced by 32.7%. The decrease in the number of antiglaucoma medications was statistically significant at each follow-up visit compared to the baseline. The qualified success rate was 40.6%. All patients at the 60-month follow-up visit required the use of antiglaucoma medications-none of the patients achieved complete success. During the follow-up period, nine patients (28.3%) that required retreatment due to nonachievement of the target IOP were considered failures. Six patients (15.8%) were lost from the follow-up. A total of 23 patients were evaluated 60 months after their phaco-ECP. Complications directly associated with the procedure, such as corneal edema (25.6%), IOP spikes (20.5%), IOL dislocation (2.6%), and uveitis (12.8%), were observed in our patients. Hypotony was not observed in any of our patients.
CONCLUSIONS: The phaco-ECP procedure was effective, well-tolerated, and safe for reducing IOP in glaucoma patients with cataracts over a long-term follow-up. Randomized, larger-scale studies are required to validate the results obtained.