小梁消融术治疗开角型青光眼的长期随访观察

Long-Term Outcomes of Trabectome in the Treatment of Open Angle Glaucoma

目的对小梁消融术治疗开角型青光眼的长期安全性和有效性进行观察。方法对42例原发或继发性开角型青光眼患者行小梁消融术，其中34例联合白内障超声乳化手术。随访最长时间为51个月，达24个月者为13例（31．0％），达12个月者为30例（71％）。以术后3月后随机2次随访眼压均≤21mmHg、眼压下降≥20％（包括使用降眼压药物）、无需二次手术为手术成功判定标准进行结果分析。结果患者术后12个月眼压平均降低24％，术后24个月平均降低20％。术前使用降眼压药物平均为（2．1±0．9）种，术后12个月平均用局部降眼压药（1．0±0．7）种，术后24个月平均用局部降眼压药（1．5±1．0）种，术后使用局部降眼压药物数量减少有统计学意义（P〈0．05）。所有患眼手术顺利，术中可见Schlemm管返血，术后2例前房少量出血均在1-2日内自行吸收。12个月的总体手术成功率为78％，24个月的总体成功率为64％。在小梁消融联合白内障超声乳化手术的病例中，12个月的总体成功率为96％，24个月的总体成功率为90％。有3例患者分别在术后的1-3个月内接受了小梁切除术的治疗。结论小梁消融术手术并发症少、术后降眼压效果明确，小梁消融术联合白内障超声乳化手术治疗开角型青光眼的成功率更高。

Objective Objective： To evaluate the safety and efficacy of Trabectome in the treat- merit of open angle glaucoma. Methods A total of 42 cases were recruited in the study including primary or secondary open angle glaucoma. All cases had undergone Trabectome, and 34 cases had undergone Trabectome combined with phacoemulsification cataract extraction. Major outcomes include intraocular pressure （IOP）, number of glaucoma medications and complications, if any. Success was defined as IOP ~〈 21mmHg, at least 20% IOP reduction in any two consecutive visits after 3 mouths （with or without medication） and no additional glaucoma surgery needed. Results The lon- gest follow-up period was 51 months, and 13 cases （31%） have been followed up at least 24 months and 30 cases （71%） have been followed up at least 12 months. IOP was reduced 24% and 20%, at 12 and 24 months after operation, respectively. The number of glaucoma medications was reduced from 2.1±0.9 to 1.0±0.7 at 12 months and to 1.5±1.0 at 24 months with statistical signifi- cance （P 〈 0.05）. All surgeries were successful with blood reflux during the surgery. Mild hyphema was seen in 2 cases, which was absorbed within 2 days. The survival rate was 78% at 12 months and 64% at 24 months. In the group of combined phacoemulsification, the survival rate was 96% at 12 months and 90% at 24 months. Three cases required additional glaucoma surgery. Conclusions Trabectome is a safe and effective minimally invasive glaucoma surgery, with less complications. Combining with phacoemulsification, Trabectome showed higher successful rate in the treatment of open angle glaucoma.