目的:比较滤过性手术与透明晶状体摘除对年轻药物未控制的闭角型青光眼(ACG)患者的疗效。
方法:回顾性,非随机化,比较,介入研究。
方法:我们回顾了以下情况患者的医疗图表:(1)年龄≤40岁,(2)诊断ACG无白内障,包括原发性闭角型青光眼(PACG),纳米眼科ACG和ACG合并视网膜营养不良,(3)ACG接受滤过手术或透明晶状体摘除。主要结果包括眼内压(IOP),药物的数量,最佳矫正视力,术后早期(1周内)和晚期(>3个月)随访发现严重并发症。
结果:可获得来自130名年轻ACG患者的160只眼的数据。76PACG的眼睛,12纳米眼科ACG,26名患有视网膜疾病的ACG接受了过滤手术,而眼睛有22PACG,12纳米眼科ACG,12例患有视网膜疾病的ACG接受了透明晶状体摘除。总的来说,在每个ACG亚组的术后晚期,滤过手术和透明晶状体摘除导致IOP和药物显著但相当的降低,两种治疗的完全成功率相似(P>0.05)。关于安全,滤过手术和视网膜疾病是术后恶性青光眼的独立相关因素(两种多变量logistic回归模型均P<0.05)。
结论:这项研究强调,在医学上不受控制的年轻ACG中,透明晶状体摘除的疗效与过滤手术相当,但是清晰的镜头提取更安全,特别是对于患有视网膜疾病的年轻ACG。
To compare the effect of filtering surgery versus clear lens extraction in young patients with medically uncontrolled angle-closure glaucoma (ACG).
Retrospective, nonrandomized, comparative, interventional study.
We reviewed the medical charts of patients with the following scenarios: (1) age ≤40 years; (2) diagnosis of ACG without cataract, including primary angle-closure glaucoma (PACG), nanophthalmic ACG, and ACG combined with retinal dystrophies; and (3) ACG undergoing filtering surgery or clear lens extraction. The main outcomes including intraocular pressure (IOP), number of medications, best-corrected visual acuity, and severe complications were extracted at the postoperative early (within 1 week) and late stage (>3 months) follow-up.
Data from 160 eyes of 130 young patients with ACG were available. Eyes with 76 PACG, 12 nanophthalmic ACG, and 26 ACG with retinal diseases underwent filtering surgery, whereas eyes with 22 PACG, 12 nanophthalmic ACG, and 12 ACG with retinal diseases received clear lens extraction. Overall, filtering surgery and clear lens extraction resulted in significant but comparable IOP and drug reductions at the postoperative late stage in each ACG subgroup, with similar complete success rates between 2 treatments (all P > .05). Regarding the safety, filtering surgery and patients with retinal diseases were independent factors associated with postoperative malignant glaucoma (P < .05 in both multivariable logistic regression models).
This study highlights that the efficacy of clear lens extraction is comparable to that of filtering surgery in medically uncontrolled ACG in young patients, but clear lens extraction is safer, especially for young patients with ACG comorbid with retinal diseases.