Is Intraocular Pressure in the Early Postoperative Period Predictive of Antimetabolite-Augmented Filtration Surgery Success?
Is Intraocular Pressure in the Early Postoperative Period Predictive of Antimetabolite-Augmented Filtration Surgery Success?
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DOI：
10.1097/01.ijg.0000185420.87865.c8
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发表时间：
2005-12
影响因子：
2
通讯作者：
L. Polikoff;A. Taglienti;R. Chanis;J. Ramos-Esteban;Nicholas Donas;J. Tsong;D. J. Gagliuso;J. Danias;J. Serle
中科院分区：
文献类型：
--
作者：
L. Polikoff;A. Taglienti;R. Chanis;J. Ramos-Esteban;Nicholas Donas;J. Tsong;D. J. Gagliuso;J. Danias;J. Serle
目的：确定小梁切除术或联合超声乳化-小梁切除术后早期眼内压（IOP）是否与当时认为成功的手术一年内的IOP相关。设计：回顾性病例系列。方法：对1994年1月至2000年11月期间由DJG和JBS进行的抗代谢物增强手术进行的图表回顾，确定了82例原发性或继发性小梁切除术和53例超声乳化联合小梁切除术，随访至少1年。计算各手术亚组的成功率，并将术后第1天IOP (POD±SD) 1、7（±2）、30（±5）、90（±10）、180（±20）与1年（POY 1, 12 ~ 15个月）IOP进行线性回归。比较使用和不使用降眼压药物一年内取得成功的眼睛在每个时间点的眼压。结果：抗代谢物增强小梁切除术82眼和联合手术53眼随访1年以上，手术成功率分别为87.8%（72 / 82眼）和92.5%（49 / 53眼）。其中，小梁切除术组39例患者中的42只眼（58.3%）和联合手术组24例患者中的27只眼（55.1%）在术后一年内不需要青光眼药物治疗，被认为是完全成功的手术。小梁切除术组术前平均IOP mm Hg±SD为26.0±8.5，光小梁切除术组术前平均IOP mm Hg±SD为18.2±4.5。小骨切除术组POY 1、POD 7、POD 30、POD 90、POD 180、POY 1眼术后IOP分别为13.9±10.4、9.5±6.2、12.0±5.5、12.0±5.2、12.8±5.9、12.1±4.3，联合手术组为20.8±12.5、9.7±5.7、12.2±5.4、11.1±3.4、11.6±4.6、10.3±4.3。小梁切除术组术后第一天的眼压与POY 1时的眼压相关性较差（R2 = 0.0788），而联合手术组则完全不相关（R2 = 0.018）。小梁切除术组术后第90天的眼压相关性略好（R2 = 0.546），联合组术后第180天的眼压相关性略好（R2 = 0.37），但仍然很低。小梁切除术组在POY 1时需要使用青光眼药物的眼睛在POY 30时和所有后续就诊时的眼压高于不需要这些药物的眼睛（P < 0.009）。在POY 1时需要青光眼药物治疗的眼，在POY 30、POY 180和POY 1时的眼压高于不需要这些药物治疗的眼（P < 0.0025）。结论：术后早期眼压与抗代谢物增强小梁切除术或白内障摘出联合小梁切除术后1年的眼压相关性极低。青光眼术后1个月开始，眼内压明显降低，术后1年最终不需要使用降压药取得临床成功。
Purpose:To determine whether intraocular pressure (IOP) in the early postoperative period after trabeculectomy or combined phacoemulsification-trabeculectomy, augmented with antimetabolite, correlates with IOP at one year in surgeries considered to be successful at that time point. Design:Retrospective case series. Methods:A chart review of antimetabolite-augmented surgical procedures done by DJG and JBS between January 1994 and November 2000 identified 82 primary or secondary trabeculectomies and 53 combined phacoemulsification-trabeculectomies with at least one year of follow-up. The success rate for each surgical subgroup was calculated and IOP on postoperative days (POD ± SD) 1, 7 (±2), 30 (±5), 90 (±10), and 180 (±20) was correlated with IOP at one year (POY 1, between month 12 and 15) using linear regression. IOP at each time point was compared among eyes that achieved success at one year with and without the use of IOP-lowering agents. Results:Of the 82 eyes having undergone antimetabolite-augmented trabeculectomies and the 53 eyes having undergone combined surgeries with at least one year of follow-up, the surgical success rates at POY 1 were 87.8% (72 of 82 eyes) and 92.5% (49 of 53 eyes). Of these, 42 eyes (58.3%) from 39 patients in the trabeculectomy group and 27 eyes (55.1%) from 24 patients in the combined surgery group did not require glaucoma medications at one year postsurgically, and were considered complete surgical successes. Mean preoperative IOP mm Hg ± SD was 26.0 ± 8.5 for the trabeculectomy group and 18.2 ± 4.5 for the phaco-trabeculectomy group. Postoperative IOP at POD 1, POD 7, POD 30, POD 90, POD 180, and POY 1 respectively for the eyes undergoing trabeculectomy were 13.9 ± 10.4, 9.5 ± 6.2, 12.0 ± 5.5, 12.0 ± 5.2, 12.8 ± 5.9, and 12.1 ± 4.3, and for the combined surgery group were 20.8 ± 12.5, 9.7 ± 5.7, 12.2 ± 5.4, 11.1 ± 3.4, 11.6 ± 4.6, and 10.3 ± 4.3. Intraocular pressure on postoperative day one correlated poorly with intraocular pressure at POY 1 for the trabeculectomy group (R2 = 0.0788), and not at all for the combined procedures group (R2 = 0.018). The correlation was slightly better for intraocular pressure at postoperative day 90 for the trabeculectomy group (R2 = 0.546), and at postoperative day 180 for the combined group (R2 = 0.37), but still rather low. Eyes requiring glaucoma medication use at POY 1 in the trabeculectomy group had higher (P < 0.009) intraocular pressure at POD 30 and at all subsequent visits than eyes not requiring these medications. Eyes requiring glaucoma medication use at POY 1 in the phaco-trabeculectomy group had higher (P < 0.0025) intraocular pressure at POD 30, POD 180, and POY 1 than eyes not requiring these medications. Conclusion:Intraocular pressure in the early postoperative period correlates very poorly with intraocular pressure one year after successful antimetabolite-augmented trabeculectomy or combined cataract extraction and trabeculectomy. Starting one month after glaucoma surgery, intraocular pressure is substantially lower in eyes that will ultimately not require the use of ocular hypotensive agents to achieve clinical success one year postoperatively.