超声乳化联合小梁切除术及术中应用5-氟尿嘧啶治疗青光眼合并白内障的长期疗效观察

The long-term effect of phacoemulsification combined with trabeculectomy and intraoperative 5-fluorouracil in glaucoma patients

目的探讨超声乳化联合小梁切除术及术中应用5氟尿嘧啶(5fluorouracil,5Fu)治疗青光眼合并白内障的疗效。方法对1996年1月至1998年12月,在新加坡国立眼科中心行超声乳化联合小梁切除术及术中应用5Fu治疗的71例(71只眼)原发性开角型青光眼(POAG)和原发性闭角型青光眼(PACG)患者的临床资料进行回顾性分析。除外随访时间<6个月的患者。结果术后患者平均眼压和平均用药种数均较术前明显降低,差异有统计学意义(P<001)。术后随访1~5年的患者眼压与术前比较均明显下降,差异有统计学意义(P<001)。手术完全成功率1、3及5年分别为842%、627%及553%。在手术完全成功的条件下,POAG与PACG(P=0281)、同一切口与不同切口(P=0487)手术疗效比较(采用Cox模型进行多因素生存分析),手术成功率差异无统计学意义(P>005)。但POAG与PACG术后平均眼压比较,差异有统计学意义(P=002)。术后较术前平均视力提高差异有统计学意义(P<001)。术后与术前平均视野缺损(MD)值(P=055)和模式标准差(PSD)值(P=064)比较,差异无统计学意义,表明患者术后视野保持稳定。术后4d发生眼内炎1例,术后晚期由于脉络膜渗漏和伤口漏引起低眼压2例。结论超声乳化联合小梁切除术及术中应用5Fu治疗POAG和PACG的成功率高,手术安全,长期观察疗效稳定。

Objective This study was designed to evaluate the long-term effect of phacoemulsification, lens implantation combined with trabeculectomy augmented with 5-Fluorouracil ^(phaco-trab-5-Fu) in Asian glaucoma patients with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Methods This retrospective study included 71 consecutive patients who underwent phaco-trab-5-Fu in Singapore National Eye Center between January 1996 and December 1998. Patients with follow-up time less than 6 months were excluded from the study. Results The mean follow-up time was (53.1±20.9)months. Postoperative IOP was significantly lower than preoperation〔(15.0±4.0)mm Hg(1 mm Hg=0.133 kPa), (20.3±5.4)mm Hg, respectively, P<0.01〕. Postoperative number of antiglaucoma medications was also significantly decreased than preoperation (P<0.01). IOP of 1 to 5 years postoperation dropped significantly from that of preoperation (P<0.01). Complete success (CS) rate of phaco-trab-5-Fu was 84.2%, 62.7%, 55.3% for 1, 3, 5years, respectively. There were neither significant difference found in PACG group and POAG group, or in single-incision and separate-incision of CS rate. But mean IOP of last follow-up was significantly different between PACG and POAG[mean IOP (13.8±4.6)mm Hg, (16.2±3.7) mm Hg, respectively, P=0.02]. According to LogMAR chart, mean preoperative visual acuity (VA) and postoperative VA were 0.75±0.40 and 0.46±0.46, respectively. Postoperative VA was significantly improved (P<0.01). In visual field, MD were (-16.6±8.8) dB and (-17.6±10.1) dB at preoperation and postoperation, respectively. PSD were (6.2±2.9) dB and (6.5±3.2) dB correspondingly. There were no significant difference in both MD and PSD (P=0.55, 0.64, respectively). One patient had early endophthalmitis and required vitrectomy. Two late-onset of hypotony were due to choroidal effusion and wound leak. Conclusions Phacoemulsification combined with trabeculectomy and ~5-Fu could be a successful and safe treatment for patients with cataract and primary glaucoma in a long run. There is no difference in success rate in PACG and POAG, or in single incision or separate incision in such combined surgery.(Chin J Ophthalmol,2005,41:128-131)