PURPOSE: To evaluate tonometric outcomes of trabeculectomy with mitomycin C in pseudophakic patients with open-angle glaucoma and associated risk factors for failure. DESIGN: Retrospective cohort study. METHODS: Seven...PURPOSE: To evaluate tonometric outcomes of trabeculectomy with mitomycin C in pseudophakic patients with open-angle glaucoma and associated risk factors for failure. DESIGN: Retrospective cohort study. METHODS: Seventythree pseudophakic patients (89 eyes) with primary open-angle, normal-tension, exfoliative, or pigmentary glaucoma were recruited. Success rates were defined according to three criteria: (A) intraocular pressure (IOP) ≤ 18 mm Hg and IOP reduction < 20% ; (B) IOP ≤ 15 mm Hg and IOP reduction < 25% ; and (C) IOP ≤ 12 mm Hg and IOP reduction < 30% . IOP, visual acuity, complications, and additional interventions were doc-umented after surgery. Cox’s proportional hazard regression analysis was used to identify risk factors for failure. RESULTS: Mean IOP (± SD) decreased from a preoperative value of 18.8± 6.6 mm Hg to 10.2± 5.1 mm Hg at one year and to 10.0± 4.2 at two years (P < .001 for both). Average number of preoperative medications decreased from 3.0± 1.1 to 0.5 ± 1.0 at one year and to 0.5± 0.9 at two years (P < .001 for both). For criteria A, B, and C, success rates (± SE) were 87% ± 4% , 83% ± 5% , and 76% ± 5% at 1 year and 67% ± 4% , 58% ± 8% , and 50% ± 7 at two years. Laser suture lysis was performed in 30 eyes, and 11% of those required a second glaucoma procedure. CONCLUSION: Increasing age, use of a limbus-based conjunctival flap, and performance of laser suture lysis were factors that were associated with a smaller risk of failure. Present findings indicate that trabeculectomy with mitomycin C provides acceptable long-term success rates in pseudophakic patients, with a low incidence of complications.展开更多
To test the hypothesis that cataract extraction in glaucomatous eyes improves overall sensitivity of visual function without affecting the size or depth of gl aucomatous scotomas. Experimental study with no control gr...To test the hypothesis that cataract extraction in glaucomatous eyes improves overall sensitivity of visual function without affecting the size or depth of gl aucomatous scotomas. Experimental study with no control group. One hundred fifty -eight eyes (of 140 patients) from the Advanced Glaucoma Intervention Study wit h at least two reliable visual fields within a year both before and after catara ct surgery were included. Average mean deviation (MD), pattern standard deviatio n (PSD), and corrected pattern standard deviation (CPSD) were compared before an d after cataract extraction. To evaluate changes in scotoma size, the number of abnormal points (P < . 05) on the pattern deviation plot was compared before and after surgery. We described an index (“scotoma depth index”) to investigate c hanges of scotoma depth after surgery. Mean values for MD, PSD, and CPSD were-1 3.2, 6.4, and 5.9 dB before and-11.9, 6.8, and 6.2 dB after cataract surgery (P ≤. 001 for all comparisons). Mean (±SD) number of abnormal points on pattern deviation plot was 26.7±9.4 and 27.5±9.0 before and after cataract surgery, re spectively (P=. 02). Scotoma depth index did not change after cataract extractio n (-19.3 vs-19.2 dB, P=. 90). Cataract extraction caused generalized improveme nt of the visual field, which was most marked in eyes with less advanced glaucom atous damage. Although the enlargement of scotomas was statistically significant , it was not clinically meaningful. No improvement of sensitivity was observed i n the deepest part of the scotomas.展开更多
文摘PURPOSE: To evaluate tonometric outcomes of trabeculectomy with mitomycin C in pseudophakic patients with open-angle glaucoma and associated risk factors for failure. DESIGN: Retrospective cohort study. METHODS: Seventythree pseudophakic patients (89 eyes) with primary open-angle, normal-tension, exfoliative, or pigmentary glaucoma were recruited. Success rates were defined according to three criteria: (A) intraocular pressure (IOP) ≤ 18 mm Hg and IOP reduction < 20% ; (B) IOP ≤ 15 mm Hg and IOP reduction < 25% ; and (C) IOP ≤ 12 mm Hg and IOP reduction < 30% . IOP, visual acuity, complications, and additional interventions were doc-umented after surgery. Cox’s proportional hazard regression analysis was used to identify risk factors for failure. RESULTS: Mean IOP (± SD) decreased from a preoperative value of 18.8± 6.6 mm Hg to 10.2± 5.1 mm Hg at one year and to 10.0± 4.2 at two years (P < .001 for both). Average number of preoperative medications decreased from 3.0± 1.1 to 0.5 ± 1.0 at one year and to 0.5± 0.9 at two years (P < .001 for both). For criteria A, B, and C, success rates (± SE) were 87% ± 4% , 83% ± 5% , and 76% ± 5% at 1 year and 67% ± 4% , 58% ± 8% , and 50% ± 7 at two years. Laser suture lysis was performed in 30 eyes, and 11% of those required a second glaucoma procedure. CONCLUSION: Increasing age, use of a limbus-based conjunctival flap, and performance of laser suture lysis were factors that were associated with a smaller risk of failure. Present findings indicate that trabeculectomy with mitomycin C provides acceptable long-term success rates in pseudophakic patients, with a low incidence of complications.
文摘To test the hypothesis that cataract extraction in glaucomatous eyes improves overall sensitivity of visual function without affecting the size or depth of gl aucomatous scotomas. Experimental study with no control group. One hundred fifty -eight eyes (of 140 patients) from the Advanced Glaucoma Intervention Study wit h at least two reliable visual fields within a year both before and after catara ct surgery were included. Average mean deviation (MD), pattern standard deviatio n (PSD), and corrected pattern standard deviation (CPSD) were compared before an d after cataract extraction. To evaluate changes in scotoma size, the number of abnormal points (P < . 05) on the pattern deviation plot was compared before and after surgery. We described an index (“scotoma depth index”) to investigate c hanges of scotoma depth after surgery. Mean values for MD, PSD, and CPSD were-1 3.2, 6.4, and 5.9 dB before and-11.9, 6.8, and 6.2 dB after cataract surgery (P ≤. 001 for all comparisons). Mean (±SD) number of abnormal points on pattern deviation plot was 26.7±9.4 and 27.5±9.0 before and after cataract surgery, re spectively (P=. 02). Scotoma depth index did not change after cataract extractio n (-19.3 vs-19.2 dB, P=. 90). Cataract extraction caused generalized improveme nt of the visual field, which was most marked in eyes with less advanced glaucom atous damage. Although the enlargement of scotomas was statistically significant , it was not clinically meaningful. No improvement of sensitivity was observed i n the deepest part of the scotomas.
