Schlemm管为基础的青光眼内引流手术术后眼压分布特征

The Distribution of Intraocular Pressure after Schlemm's Canal-Based Internal Filtration Surgery

目的:分析以Schlemm管为基础的各类型青光眼内引流手术术后眼压分布特征。方法:回顾性系列病例研究。选取2015年6月至2019年1月于温州医科大学附属眼视光医院行以Schlemm管为基础的青光眼内引流手术(黏小管成形术和穿透性黏小管成形术)的患者资料,入选其中随访时间≥6个月,且末次随访在未用药情况下眼压≤21 mmHg(1 mmHg=0.133 kPa)患者,分析患者的眼压分布特征。各类型青光眼的眼压比较采用单因素方差分析。结果:共纳入患者204例(236眼),术前眼压为(33.4±12.1)mmHg,用药(2.7±1.2)种。术后末次随访时(6个月及以上)眼压为(13.9±3.3)mmHg。其中眼压分布在5~10 mmHg有37眼(15.7%),分布在>10~12 mmHg有43眼(18.2%),分布在>12~15 mmHg有78眼(33.1%),分布在>15~18 mmHg有56眼(23.7%),分布在>18~21 mmHg有22眼(9.3%)。原发性开角型青光眼(85眼)、原发性闭角型青光眼(30眼)、继发性青光眼(76眼)和先天性青光眼(45眼)的末次随访眼压分别为(13.9±3.2)(14.5±3.0)(14.0±3.3)(13.2±3.7)mmHg,各类型青光眼总体眼压差异无统计学意义(F=1.011,P=0.289)。对于原发性开角型青光眼,早、中、晚期青光眼的目标眼压达标率分别为82.4%、81.8%、36.8%。结论:以Schlemm管为基础的青光眼内引流手术术后平均眼压为14 mmHg,80%的早、中期以及1/3的晚期原发性开角型青光眼患者可以达到目标眼压。

Objective:To analyze the intraocular pressure(IOP)distribution characteristics after successful Schlemm's canal-based internal filtration surgery.Methods:In this retrospective series of case study,patients were collected from the Schlemm's canal-based surgery study(including canaloplasty and penetrating canaloplasty)in the Eye Hospital,Wenzhou Medical University during June 2015 to January 2019.Statistical analysis was carried out for those who met the inclusion criteria:Follow-up≥6 months and the postoperative IOP during the last follow-up was≤21 mmHg(1 mmHg=0.133 kPa)without medication.IOP of different types were compared by one-way ANOVA.Results:A total of 204 patients(236 eyes)were enrolled in the statistical analysis.All 236 eyes had a mean preoperative IOP of(33.4±12.1)mmHg and mean glaucoma medication use of(2.7±1.2).Postoperative IOP data formed a normal distribution,with a mean IOP of(13.9±3.3)mmHg.There was no eye with an postoperative IOP below 5 mmHg.Postoperative IOP of patients with different types of glaucoma(primary open-angle glaucoma,primary angle-closure glaucoma,secondary glaucoma,and congenital glaucoma)all formed normal distribution,and the mean IOP were(13.9±3.2)mmHg,(14.5±3.0)mmHg,(14.0±3.3)mmHg,and(13.2±3.7)mmHg,respectively,with no statistically significant difference between the groups(F=1.011,P=0.289).In primary open-angle glaucoma eyes,target IOP was achieved in 82.4%of early glaucoma,81.8%moderate glaucoma and 36.8%advanced glaucoma.Conclusions:The average IOP after Schlemm's canal-based internal filtration surgery is about 14 mmHg.Target IOP is achieved in about 80%of eyes in primary open-angle glaucoma with early-stage and moderate-stage and one-third of eyes with advanced stage.