Long-term Outcomes of Combined Phacotrabeculectomy Surgery in a Singapore Tertiary Hospital

IF 3.7 3区 医学 Q1 OPHTHALMOLOGY Asia-Pacific Journal of Ophthalmology Pub Date : 2024-09-01 DOI:10.1016/j.apjo.2024.100102
Annabel CY Chew , Hla Myint Htoon , Shamira A. Perera , Tin Aung , Ho Ching Lin , Rahat Husain , Boey Pui Yi , Daniel Hsien Wen Su , Jocelyn Chua , Tina T. Wong
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Abstract

Purpose

To describe the long-term outcomes of phacotrabeculectomy from a tertiary glaucoma service in Singapore.

Design

Retrospective case series.

Methods

Seven hundred ninety-six eyes of 698 patients who underwent phacotrabeculectomy surgery at the Singapore National Eye Centre between 2005 and 2007 with a minimum follow-up of three years were included. The primary outcome measure was intraocular pressure (IOP). Secondary outcomes included best-corrected visual acuity (BCVA), number of glaucoma medications, and surgical complications.

Results

The mean age was 69.5 years, 51 % were male, and 86 % were Chinese. Most eyes had primary glaucoma (90.6 %). The mean follow-up duration was 9.4 years. The overall success rate at three years was 97 % if surgical success was defined as IOP ≤ 21 mm Hg, 92 % if IOP ≤ 18 mm Hg, 66 % if IOP ≤ 15 mm Hg. By Kaplan–Meier survival analysis over 13 years, the cumulative success rate fell from 98.1 % to 89.1 % if IOP ≤ 21 mm Hg, 98.1–76.9 % if IOP ≤ 18 mm Hg, 98–50.3 % if IOP ≤ 15 mm Hg. The postoperative IOP improved significantly at all time points (P < 0.05) and 72 % had at least 20 % IOP reduction. There was a slight improvement in postoperative BCVA (P < 0.05). The mean number of glaucoma medications was reduced postoperatively (P < 0.001). There were no significant risk factors for surgical failure.

Conclusions

Phacotrabeculectomy was found to be safe, resulting in clinically significant IOP lowering for 13 years with reduced dependency on glaucoma medications and improved BCVA.
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新加坡一家三级医院的咽喉切除联合手术的长期疗效。
目的:描述新加坡一家三级青光眼服务机构的虹膜睫状体切除术的长期疗效:设计:回顾性病例系列:方法:纳入 2005 年至 2007 年期间在新加坡国立眼科中心接受青光眼超声乳化手术的 698 名患者中的 796 只眼睛,随访至少三年。主要结果是眼压(IOP)。次要结果包括最佳矫正视力(BCVA)、青光眼用药次数和手术并发症:平均年龄为 69.5 岁,51% 为男性,86% 为中国人。大多数眼睛患有原发性青光眼(90.6%)。平均随访时间为 9.4 年。如果将手术成功定义为眼压≤21毫米汞柱,三年后的总成功率为97%;如果眼压≤18毫米汞柱,总成功率为92%;如果眼压≤15毫米汞柱,总成功率为66%。通过13年的卡普兰-米尔生存分析,如果眼压≤21毫米汞柱,累计成功率从98.1%降至89.1%;如果眼压≤18毫米汞柱,累计成功率从98.1%降至76.9%;如果眼压≤15毫米汞柱,累计成功率从98%降至50.3%。术后眼压在所有时间点均有明显改善(P < 0.05),72%的患者眼压至少降低了 20%。术后 BCVA 略有改善(P < 0.05)。术后青光眼药物的平均数量有所减少(P < 0.001)。手术失败没有明显的风险因素:法氏囊切除术是一种安全的手术,可在13年内显著降低眼压,减少对青光眼药物的依赖,改善BCVA。
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来源期刊
CiteScore
8.10
自引率
18.20%
发文量
197
审稿时长
6 weeks
期刊介绍: The Asia-Pacific Journal of Ophthalmology, a bimonthly, peer-reviewed online scientific publication, is an official publication of the Asia-Pacific Academy of Ophthalmology (APAO), a supranational organization which is committed to research, training, learning, publication and knowledge and skill transfers in ophthalmology and visual sciences. The Asia-Pacific Journal of Ophthalmology welcomes review articles on currently hot topics, original, previously unpublished manuscripts describing clinical investigations, clinical observations and clinically relevant laboratory investigations, as well as .perspectives containing personal viewpoints on topics with broad interests. Editorials are published by invitation only. Case reports are generally not considered. The Asia-Pacific Journal of Ophthalmology covers 16 subspecialties and is freely circulated among individual members of the APAO’s member societies, which amounts to a potential readership of over 50,000.
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