晚期开角型青光眼小梁切除术后视力下降原因分析

Analysis of causes of vision loss after trabeculectomy in advanced open-angle glaucoma

目的:分析晚期开角型青光眼(POAG)小梁切除术后视力下降的原因。方法:前瞻性研究。分析青岛市黄岛区中医医院2014年3月到2018年6月行小梁切除术的晚期POAG 120例(240眼)的一般资料,随访1年,分为视力下降组[15例(30眼)]与视力未下降组[90例(180眼)],分析视力下降的危险因素。结果:小梁切除术后视力下降者占12.50%(15/120)。眼压是术后视力下降的独立危险因素(OR=1.728,P=0.008);OCT检查的多项参数与视力下降相关,视野缺损、视网膜神经纤维层厚度及黄斑神经节细胞内丛状层厚度是独立保护性因素(OR=0.004,0.853,0.765;P=0.008,0.000,0.002)。结论:眼压为晚期POAG小梁的切除术后视力下降的独立危险因素,视野缺损、视网膜神经纤维层厚度、黄斑神经节细胞内丛状层厚度是其保护因素。

Objective To analyze the causes of vision loss after trabeculectomy in advanced primary open-angle glaucoma(POAG).Methods This was a prospective study.Total of 240 eyes of 120 patients with advanced POAG who underwent trabeculectomy from Mar.2014 to Jun.2018 in Huangdao District Traditional Chinese Medicine Hospital of Qingdao were analyzed.All cases were followed up for 1 year.All cases were divided into two groups,30 eyes of 15 cases in the visual impaired group and the visual unimpaired group with 180 eyes of 90 cases.The risk factors of vision loss were analyzed.Results Postoperative vision loss occurred in 30 eyes of 15 cases(12.50%).The intraocular pressure was an independent risk factor of vision loss after surgery in advanced POAG(OR=1.728,P=0.008).Multiple parameters of the OCT examination were associated with decreased vision after trabeculectomy in advanced POAG.The mean visual field defect,retinal nerve fiber layer thickness,and macular ganglion cell substratum thickness were independent protective factors(OR=0.004,0.853,0.765;P=0.008,0.000,0.002).Conclusion Intraocular pressure is an independent risk factor of vision loss after surgery in advanced POAG.The visual field defect,the thickness of the retinal nerve fiber layer and the macular ganglion cell substratum thickness are the protective factors.