比较闭角型青光眼患者接受导管切除术和小梁切除术的疗效。

IF 2.8 Q1 OPHTHALMOLOGY Ophthalmology. Glaucoma Pub Date : 2024-09-01 DOI:10.1016/j.ogla.2024.04.005

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引用次数: 0

摘要

目的比较闭角型青光眼（ACG）患者接受导管分流手术（Tube）和小梁切除术加丝裂霉素 C（Trab-MMC）的疗效.设计回顾性非随机比较研究.参与者2015 年 1 月至 2022 年 1 月期间在马萨诸塞州眼耳科接受导管分流手术（Tube）（50 例）或小梁切除术加丝裂霉素 C（Trab-MMC）（30 例）治疗的 80 名 ACG 患者的 80 只眼睛.主要结果指标卡普兰-迈尔（KM）成功率、眼压（IOP）、用药负担、最佳矫正视力（BCVA）、调整后危险比（HRs）和并发症。结果两组患者的基线人口统计学特征相似，只是Tube组患者中患有假性角膜和曾接受过眼部切口手术的比例较高。Trab-MMC手术的KM完全成功率（CS）明显高于Tube手术，但合格成功率（QS）相似。在 QS 条件下，第 1 年，Tube 组的累积存活概率为 87%，Trab-MMC 组为 83%（P = 0.77）；第 2 年，Tube 组为 75%，Trab-MMC 组为 58%（P = 0.14）。在 CS 条件下，第 1 年时 Tube 组的累积存活概率为 13%，Trab-MMC 组为 59%（P < 0.001）；第 2 年时 Tube 组的累积存活概率为 11%，Trab-MMC 组为 41%（P < 0.001）。从基线到2年，插管和Trab-MMC手术都能显著降低眼压和减少用药，插管术后平均眼压降至12.6 ± 5.9 mmHg，用药2.8 ± 1.4次；Trab-MMC术后平均眼压降至12.1 ± 6.6 mmHg，用药2.4 ± 1.7次。接受Trab-MMC治疗的患者在第一年前的每次随访中需要的降眼压药物都较少，但在第二年需要的药物数量相似。结论我们证明，在 ACG 患者中，Trab-MMC 的眼压降低率和 QS 率与 Tube 置管术相似。然而，Trab-MMC 在 1 年内减少了更多的用药负担，在 2 年内提高了 CS 率，同时仍保持了与 Tube 相似的并发症发生率。

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Comparing Outcomes of Tube Versus Trabeculectomy Among Patients with Angle-closure Glaucoma

Purpose

Compare outcomes of tube shunt surgery (Tube) and trabeculectomy with mitomycin C (Trab-MMC) in patients with angle-closure glaucoma (ACG).

Design

Retrospective nonrandomized comparative study.

Participants

A total of 80 eyes from 80 patients with ACG who underwent either Tube (N = 50) or Trab-MMC (N = 30) between January 2015 and January 2022 at Massachusetts Eye and Ear.

Methods

Reviewed and analyzed 390 visits from patient charts.

Main Outcome Measures

Kaplan-Meier (KM) success rates, intraocular pressure (IOP), medication burden, best-corrected visual acuity (BCVA), adjusted hazard ratios (HRs), and complications.

Results

Baseline demographics were similar between both groups, except for a higher proportion of patients with pseudophakia and prior incisional ocular surgery in the Tube group. The Trab-MMC procedure had significantly higher KM complete success (CS) rates than the Tube procedure, but similar qualified success (QS) rates. Under QS, the cumulative probability of survival was 87% in the Tube group and 83% in the Trab-MMC group at year 1 (P = 0.77), and 75% in the Tube group and 58% in the Trab-MMC group at year 2 (P = 0.14). Under CS, the cumulative probability of survival was 13% in the Tube group and 59% in the Trab-MMC group at year 1 (P < 0.001), and 11% in the Tube group and 41% in the Trab-MMC group at year 2 (P < 0.001). Both Tube and Trab-MMC procedures resulted in significant patterns of IOP and medication reduction from baseline up to 2 years with mean IOP reduced to 12.6 ± 5.9 mmHg on 2.8 ± 1.4 medications after Tube and 12.1 ± 6.6 mmHg on 2.4 ± 1.7 medications after Trab-MMC. Patients who underwent Trab-MMC required less IOP-lowering medications at every follow-up visit up to year 1, but a similar number at year 2. No significant differences were found in IOP reduction, BCVA, or complication rates between groups.

Conclusions

We demonstrate that Trab-MMC confers similar IOP reduction and QS rates to Tube placement in patients with ACG. Trab-MMC, however, demonstrated greater medication burden reduction up to 1 year, and more favorable CS rates up to 2 years, while still maintaining similar complication rates to Tube.