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白内障超声乳化术与青光眼白内障联合手术比较:一项人体内观察性队列研究

Dhalla, K., Cousens, S., Murdoch, I.E.

期刊名称:The British journal of ophthalmology

卷期:2017年第101卷第12期

摘要

摘要:目的:旨在比较坦桑尼亚原发性开角型青光眼(poag)患者接受青光眼白内障联合手术(PT)和超声乳化术(phaco)后的眼压下降和视力改善。地点:坦桑尼亚达姆萨拉姆 ccbrt医院。设计:个体内观察性队列研究。方法:在每个患者内,一只眼进行PT,另一只眼进行phaco。随访5-1/2年,评估每只眼的眼压和视力。对于一小部分患者,比较两个额外的术后时间点。结果:52例患者(34例男性)平均年龄70岁(SD 8岁)纳入本研究。对于那些250天以上随访患者而言,两种手术都可以降低眼压和改善视力(P <0.001)。PT组眼压平均下降50%(95Cl 4555%)和phaco 组下降41%(95Cl3646%)。PT组平均眼压为12.9mmHgphaco 16.8mmHg低(p = 0.004)。 9例患者额外随访显示,PT眼和phaco眼的首次(平均337天)和二次(平均1482天)随访(p = 0.18)眼压分别升高1.8mmHg4.2mmHg。结论:在这项针对非洲患者的小型研究中,PT比单纯超声乳化术的降眼压效果更好,但手术之间的差异相对较小。这一人群单纯白内障超声乳化术可有效的降低眼压并改善视力。鉴于白内障超声乳化术相对简单,在某些情况下是值得考虑的治疗选择。

AIM:To compare reduction in intraocular pressure (IOP) and gain in visual acuity (VA) following phacotrabeculectomy (PT) and phacoemulsification(phaco) in Tanzanian patients with primary open angle glaucoma(POAG).SETTING:CCBRT Hospital, Dar es Salaam, Tanzania.DESIGN:Within-person observational cohort study.METHODS:Within each patient, one eye had PT and the other phaco. Patients were followed for up to 5-1/2 years, and IOP and VA in each eye were assessed. For a small group of patients, two additional postoperative time points were compared.RESULTS:52 patients (34 male) with a mean age of 70 years (SD 8 years) were enrolled in the study. For those with 250 days or more follow-up, both operations resulted in lower IOPs and improved VA (p<0.001). The average drop in IOP was 50% (95%CI 45% to 55%) for PT and 41% (95% CI 36% to 46%) for phaco. Mean IOP was lower in the PT group 12.9mm Hg vs 16.8mm Hg (p=0.004). Extended follow-up in nine patients showed a rise in IOP of 1.8mm Hg for PT and 4.2mm Hg for phaco eyes between first (mean, 337 days) and second (mean 1482 days) follow-up (p=0.18).CONCLUSION:In this small study in African patients, PT resulted in lower IOPs than phacoemulsification alone but the difference between the procedures was relatively small. Phacoemulsification alone was effective in reducing IOP and improving VA for several years in this population. Given the relative simplicity of phacoemulsification, it is a therapeutic option worthy of consideration in some settings.


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