Rates of glaucomatous visual field change after trabeculectomy
Rates of glaucomatous visual field change after trabeculectomy
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DOI：
10.1136/bjophthalmol-2016-308948
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发表时间：
2017-07-01
影响因子：
4.1
通讯作者：
Nicolela, M. T.
中科院分区：
文献类型：
--
作者：
Baril, C.;Vianna, J. R.;Nicolela, M. T.
背景小梁切除术常用于病情恶化的青光眼患者，尽管其对视野（VF）进展率的影响尚不完全清楚。我们研究了小梁切除术后VF进展的速度与药物治疗的患者相匹配的VF loss.Methods进行了单独或联合白内障摘除术小梁切除术的患者的病历进行了审查。选择小梁切除术后有5次或更多24-2 VF检查的患者。计算每例患者术后的平均偏差（MD）变化率。结果180例手术患者与180例药物治疗患者（基线MD分别为-8.72（5.24）dB和-8.71（5.22）dB）进行配对。手术和药物治疗的患者分别随访7.4（2.9）年和6.8（3.1）年。手术和药物治疗患者的MD斜率分别为-0.22（0.55）dB/年和-0.08（1.10）dB/年，无统计学差异（p=0.13，95% CI -0.31至0.04）。手术组中更多的患者进展快（速率低于-1 dB/年）结论我们的研究结果表明，大多数接受小梁切除术的患者术后VF进展速度相对较慢，与药物治疗的患者相似，尽管一些患者可以继续进展，尽管眼内压得到了充分的手术控制。
Background Trabeculectomy is frequently performed in patients with glaucoma who are deteriorating, although its effects on rates of visual field (VF) progression are not fully understood. We studied the rate of VF progression post trabeculectomy comparing with medically treated patients matched for VF loss.Methods Medical records of patients who underwent trabeculectomy alone or combined with cataract extraction were reviewed. Patients with 5 or more 24-2 VF examinations post trabeculectomy were selected. The rate of mean deviation (MD) change after surgery was calculated for each patient. These patients were pairwise matched based on baseline MD with patients with glaucoma who were treated medically and had at least 5 VF tests.Results 180 surgical patients were identified and matched with 180 medically treated patients (baseline MD of -8.72 (5.24) dB and -8.71 (5.22) dB, respectively). Surgically and medically treated patients were followed for 7.4 (2.9) and 6.8 (3.1) years respectively. The MD slopes were -0.22 (0.55) dB/year and -0.08 (1.10) dB/year in the surgically and medically treated patients, respectively, and not statistically different (p=0.13, 95% CI -0.31 to 0.04). More patients in the surgical group had fast progression (rates worse than -1 dB/year) than in the medical group (17 and 7 patients, respectively, p=0.05).Conclusions Our findings suggest that most patients who undergo trabeculectomy demonstrate relatively slow rates of VF progression postoperatively, similar to patients treated medically, although some patients can continue to progress despite adequate surgical control of intraocular pressure.