青光眼患者的 Phaco-Tube 与 Phaco-Trabeculectomy 的回顾性比较。

IF 2.8 Q1 OPHTHALMOLOGY Ophthalmology. Glaucoma Pub Date : 2024-09-01 DOI:10.1016/j.ogla.2024.04.008

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引用次数: 0

摘要

目的：比较既往未接受过眼部切口手术的患者接受超声乳化联合贝维尔特植入术（phaco-tube）或小梁切除术联合丝裂霉素-C（MMC）（phaco-trab）的手术效果：设计：单中心、回顾性、比较性病例系列：共有 90 名患者接受了手术治疗，其中 phaco-tube 组 45 人，phaco-trab 组 45 人：方法：使用当前程序术语（CPT）代码确定符合条件的患者，并回顾性审查其病历：主要结果指标：手术失败率（眼压≤5 mmHg或>21 mmHg或降低）为主要结果指标：3年后，phaco-tube组的累计失败概率为6.7%，phaco-trab组为32.8%（P= 0.005；限制性平均生存时间=5.9个月，95% CI=1.4至10.4个月）。3年后，phaco-tube组的眼压为13.1 ± 3.4 mmHg，phaco-trab组的眼压为13.3 ± 6.2 mmHg（P= 0.90），phaco-tube组的青光眼用药次数为2.6 ± 1.5，phaco-trab组的青光眼用药次数为1.7 ± 1.3（P= 0.015）。3 年后，phaco-tube 组的 LogMAR VA 为 0.39 ± 0.58，phaco-trab 组为 0.43 ± 0.73（P= 0.82）；phaco-tube 组的 VFMD 为 -18.3 ± 9.0 dB，phaco-trab 组为 -14.1 ± 7.0 dB（P= 0.16）。phaco-tube组有21名患者（47%）出现术后并发症，phaco-trab组有15名患者（33%）出现术后并发症（P= 0.28）：结论：3年随访后，Phaco-tub与phaco-trab相比，手术失败率明显较低。然而，phaco-trabs 在术后多个时间点使用的青光眼药物明显更少，完全成功的比例更高。

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A Retrospective Comparison of Phaco-tube vs. Phaco-trabeculectomy in Glaucoma Patients

Purpose

To compare surgical outcomes of phacoemulsification combined with Baerveldt implantation (phaco-tube) or trabeculectomy with mitomycin-C (MMC) (phaco-trab) in patients without prior incisional ocular surgery.

Design

Single-center, retrospective, comparative case series.

Participants

A total of 90 patients underwent surgical treatment, including 45 patients in the phaco-tube group and 45 patients in the phaco-trab group.

Methods

Eligible patients were identified using current procedural terminology (CPT) codes, and their medical records were retrospectively reviewed.

Main Outcome Measures

The primary outcome measure was the rate of surgical failure (IOP ≤5 mmHg or >21 mmHg or reduced <20% from baseline on 2 consecutive study visits after 3 months, reoperations for glaucoma, or experienced loss of light perception vision). Patients who had successful surgical outcomes without use of glaucoma medications were classified as complete successes, while those who used glaucoma medications were classified as qualified successes. Secondary outcome measures were visual acuity (VA), visual field mean deviation (VFMD), intraocular pressure (IOP), glaucoma medication use, and complications.

Results

The cumulative probability of failure was 6.7% in the phaco-tube group and 32.8% in the phaco-trab group after 3 years (P = 0.005; Restricted Mean Survival Time = 5.9 months, 95% CI = 1.4–10.4 months). The IOP was 13.1 ± 3.4 mmHg in the phaco-tube group and 13.3 ± 6.2 mmHg in the phaco-trab group at 3 years (P = 0.90), and the number of glaucoma medications was 2.6 ± 1.5 in the phaco-tube group and 1.7 ± 1.3 in the phaco-trab group (P = 0.015). The logarithm of the minimum angle of resolution VA was 0.39 ± 0.58 in the phaco-tube group and 0.43 ± 0.73 in the phaco-trab group at 3 years (P = 0.82), and VFMD was −18.3 ± 9.0 dB in the phaco-tube group and −14.1 ± 7.0 dB in the phaco-trab group (P = 0.16). Postoperative complications developed in 21 patients (47%) in the phaco-tube group and 15 patients (33%) in the phaco-trab group (P = 0.28).

Conclusions

Phaco-tubes had a significantly lower rate of surgical failure compared to phaco-trabs after 3 years of follow-up. However, phaco-trabs used significantly fewer glaucoma medications at multiple postoperative timepoints and had a higher proportion of complete success.