活动期葡萄膜炎性青光眼患者接受小梁切除术后的炎症反应及眼压情况

Inflammatory and intraocular pressure outcomes after trabeculectomy in active uveitic glaucoma in Chinese

摘要:

目标：分析活动期葡萄膜炎患者在小梁切除术后的炎症反应及眼压情况。

方法：我们回顾了2006-10/2011-03期间，接受了小梁切除术的活动期葡萄膜炎性青光眼患者纪录。手术前后的炎症反应、复发频率、类固醇依赖度及眼压均以配对t检验作比较。

结果：在29例29眼患者中，90%的患眼在手术时正在接受局部类固醇治疗。患者平均年龄为58.3±14.0a，术前眼压为35.7±8.9mmHg。患者平均复诊时期为35.2±18.7mo。术后3mo前房炎症反应分级平均减少了0.4±0.6(P<0.01)。复发频率在复诊期内每年减少了2.3±2.1次(P<0.01)。术后1a的平均眼压为13.1±4.5mmHg，而其中44.8%患者的眼压无需用药亦能维持在21mmHg或以下。

结论：小梁切除术后的葡萄膜炎性青光眼患者在炎症反应及眼压方面均有改善，但成功率较原发性青光眼患者低。小梁切除术可以作为活动期葡萄膜炎性青光眼患者早期控制眼压和炎症反应治疗的一个选择。

Abstract:

AIM: To analyze the outcomes in uveitic activity and intraocular pressure(IOP)control after trabeculectomy for uveitis with uncontrolled IOP.

METHODS: The medical records of consecutive uveitic glaucoma patients undergoing trabeculectomy between October 2006 to March 2011 were retrospectively reviewed. Uveitic activity, frequency of recurrence, steroid dependence, and intraocular pressure control were compared with paired t-test before and after trabeculectomy.

RESULTS: In 29 eyes from 29 patients, 90% of eyes were on topical steroids at the time of trabeculectomy. The mean age was 58.3±14.0 years old with a pre-operative IOP of 35.7±8.9mmHg. The mean follow up time was 35.2±18.7mo. There was a reduction of anterior chamber activity grading of 0.4±0.6(P<0.01)at 3mo post-operatively. The uveitis recurrence rate was significantly reduced by 2.3±2.1 episodes/year(P<0.01)during the follow-up period. The mean 1y post-trabeculectomy IOP was 13.1±4.5mmHg with 44.8% of eyes with IOP≤21mmHg without medication.

CONCLUSION: Uveitic activity and IOP control improved after trabeculectomy with a lower success rate to primary glaucomas. Trabeculectomy may be considered as a possible early intervention of active uveitis with high IOP for pressure and uveitic activity control.