Schlemm管成形术治疗成年人开角型青光眼两年随访

Two years follow-up of adult patients with open angle glaucoma treated by canaloplasty

目的评估Schlemm管成形术治疗成年人开角型青光眼的有效性和安全性。设计回顾性病例系列。研究对象2011年1月至2014年4月北京同仁眼科中心接受Schlemm管成形术治疗的成年人开角型青光眼患者41例(50眼)。方法对上述患者行Schlemm管成形术治疗。术后3、6个月,1、1.5、2年进行随访。对比观察青年组与中老年组、非高度近视组与高度近视组患者的眼压以及降眼压药物使用情况。以术后不使用降眼压药物,且眼压<21 mm Hg为完全成功,术后需使用降眼压药物控制眼压<21 mm Hg为条件成功。主要指标眼压、降眼压药物应用情况。结果术前平均眼压(24.9±8.1)mm Hg,平均应用(2.7±1.2)种药物。术后3、6个月,1、1.5、2年的平均眼压分别为(15.1±3.0)mm Hg、(15.5±3.5)mm Hg、(15.4±3.1)mm Hg、(15.6±4.2)mm Hg、(15.8±4.9)mm Hg,均明显低于术前(P均=0.000)。术后2年平均应用(0.8±1.4)种药物,明显少于术前(P=0.000)。术后2年完全成功率70.3%,条件成功率92.6%。青年组与中老年组术后各时间点眼压及降眼压药物种类无统计学差异。术后1年,高度近视组眼压(14.4±3.3 mm Hg)低于非高度近视组(16.2±4.5 mm Hg)(P=0.035),其他时间点两组眼压及用降眼压药物无统计学差异。结论随访两年的结果表明,Schlemm管成形术对成年人开角型青光眼是一种安全有效的降眼压手术方式。

Objective To evaluate the efficacy and safety of canaloplasty in treating adult patients with open angle glaucoma. Design Retrospective ease series. Participants 41 cases （50 eyes） of adult patients with open-angle glaucoma treated in Beijing Ton- gren Eye Center from January 2011 to April 2014. Method All patients were conducted with canaloplasty. The patients were followed up at 3, 6 months, 1 year, 1.5 years, and 2 years after the surgery. The intraoeular pressure （IOP） and the use of IOP lowering drugs were comparative observed in youth group and middle-old age group, non-high myopia group and high myopia group. The complete success was defined as lOP was lower than 21 mmHg without any IOP lowering drugs, and conditional success was defined as IOP was lower than 21 mmHg with IOP lowering drugs. Main Outcome Measures IOP and usage status of IOP lowering drugs. Results Before the surgery, the average IOP was （24.9±8.1） mmHg, the average drug usage was （2.7±1.2） kinds of drugs. The mean IOP at 3, 6 months, 1 year, 1.5 years and 2 years after the surgery were （15.1±3.0） mmHg, （15.5±3.5） mmHg, （15.4±3.1） mmHg, （15.6±4.2） mmHg, （15.8± 4.9） mmHg, respectively, all of which were significantly lower than those before surgery （all P=O.O00）. At 2 years after surgery, the av- erage drug usage was （0.8±1.4） kinds of drugs, which was significantly less than that before surgery （P=0.000）. At 2 years after surgery, the complete success rate was 70.3%, and the conditional success rate was 92.6%. There was no significant different between the youth group and middle-old age group in IOP and IOP lowering drugs at different time point after operation. One year after surgery, IOP of high myopia group （14.4±3.3 mmHg） was lower than non-high myopia group （16.2±4.5 mmHg） （P=0.035）. There was no significant dif-ferent between two groups in IOP and IOP lowering drugs during follow-up. Conclusion Two years follow-up showed that canaloplasty is an effective and safe way to reduce IOP in adults with open angle glaucoma.