山东大学耳鼻喉眼学报 ›› 2023, Vol. 37 ›› Issue (4): 139-148.doi: 10.6040/j.issn.1673-3770.0.2022.181

• • 上一篇    

小梁消融术治疗开角型青光眼患者的长期视野缺损研究

孟素坤1,2,张纯1,2   

  1. 1.北京大学第三医院 眼科, 北京100191;
    2.眼部神经损伤的重建保护与康复北京市重点实验室, 北京 100191
  • 发布日期:2023-07-27
  • 通讯作者: 张纯. E-mail:zhangc1@yahoo.com
  • 基金资助:
    国家自然科学基金(81970798)

Long-term progress of visual field defect for open-angle glaucoma patients with ab interno trabeculotomy with the trabectome

MENG Sukun1,2, ZHANG Chun1,2   

  1. 1. Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China2. Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
  • Published:2023-07-27

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121

摘要： 目的 观察小梁消融术治疗开角型青光眼患者的长期疗效及视野缺损进展情况。 方法 回顾性队列研究。纳入62例接受小梁消融术的原发性开角型青光眼病例。主要观察指标为视野,次要观察指标包括眼压、青光眼药物使用数量和手术并发症。Wilcoxon符号秩检验用于比较手术前后的眼压和青光眼药物使用数量。使用加强版青光眼分期系统评估术前视野缺损的严重程度,将术前视野进行分期。将历次视野检查的弥漫性视野缺损参数(Octopus视野的平均缺损,Humphrey视野的平均偏差)与时间进行线性回归分析,根据回归方程斜率判断视野缺损是否进展,计算视野进展率并进一步探索视野缺损进展的影响因素。 结果 62例病例的术前眼压为(20.9±7.5)mmHg,术前青光眼药物使用数量为(2.6±1.2)种。术后5年眼压降低至(17.6±3.4)mmHg(P=0.018),用药数量减少至(2.3±1.1)种(P=0.317)。病例视野缺损出现进展共计14例,进展率为22.6%。视野缺损进展组和无进展组在糖尿病史和术前视野分期方面差异有统计学意义。有糖尿病史的病例中出现视野缺损进展的比例为46.2%,而在无糖尿病史的病例中仅16.3%(P=0.022)。术前视野分期较轻(0~3期)的病例中出现视野缺损进展的比例为38.9%,而在术前视野分期较重(4~5期)的病例中为15.9%(P=0.049)。 结论 小梁消融术的长期疗效明确;小梁消融术后仍有部分患者出现视野缺损持续进展,术后随访时应关注青光眼功能损害;有糖尿病史和术前视野分期较轻的患者出现视野缺损进展的可能性高,在术后随访时应提高随访频率、密切监测患者的视野情况。

关键词: 小梁消融术, 开角型青光眼, 视野, 微创青光眼手术, 危险因素

Abstract: Objective To observe the long-term efficacy of ab interno trabeculotomy with the Trabectome and the progress of visual field defect for open-angle glaucoma patients. Methods In this retrospective cohort study, 62 primary open-angle glaucoma patients who underwent ab interno trabeculotomy with the Trabectome were included. The main outcome measure was visual field, and the secondary outcome measures included intraocular pressure, the amount of glaucoma medications, and surgical complications. The Wilcoxon test was used to compare the postoperative intraocular pressure and the number of glaucoma medications with baselines. The Enhanced Glaucoma Staging System(GSS 2)was used to evaluate the severity of preoperative visual field defects and to stage the preoperative visual field. The parameters of diffuse visual field defect(mean defect of Octopus visual field test and mean deviation of Humphrey visual field test)in all follow-ups were analyzed by linear regression with time. Whether the visual field defect progressed or not was judged according to the slope of regression equation. Moreover, the risk factors of visual field defect progression were further explored. Results The preoperative intraocular pressure of all 62 cases was(20.9±7.5)mmHg and the preoperative number of glaucoma medications before was(2.6±1.2)species. After operation, intraocular pressure decreased to(17.6±3.4)mmHg(P=0.018)and the number of glaucoma medications decreased to(2.3±1.1)species(P=0.317)at 5 years. Fourteen cases(22.6%)experienced progression of visual field defects. There were differences in the history of diabetes and preoperative visual field staging between the two groups. The proportion of progressive cases in cases with diabetes was 46.2% compared to 16.3% in cases without diabetes(P=0.022). The percentage of progression of visual field defect was 38.9% in cases with mild preoperative visual field staging(stages 0-3)and 15.9% in cases with severe preoperative visual field staging(stages 4-5)(P=0.049). Conclusion Ab interno trabeculotomy with the Trabectome had a definite long-term efficacy. Some patients still had visual field defects progression after operation. Visual functional impairment of glaucoma should be considered during postoperative follow-up. Patients with diabetes and mild preoperative visual field stage were more likely to have visual field defects progression. The follow-up frequency of these patients should be increased and their visual field should be frequently monitored.

Key words: Ab interno trabeculotomy, Open-angle glaucoma, Visual field, Minimally invasive glaucoma surgeries, Risk factor

中图分类号: 

  • R775
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