| Objective:Glaucoma,as the first irreversible blinding disease of theworld,it is not a single disease process.Its treatments include medicines, laserand surgery. When medication and laser therapy failed, surgery has becomethe first choice of patients. Trabeculectomy is the most commonly usedanti-glaucoma filtering surgery and the most representative protective filteringsurgery, also experienced continuous improvement and development.Trabeculectomy focused primarily on preventing scar formation in recentyears, such as trabeculectomy combined with anti-metabolism drugs andtheir delivery system, new surgical techniques,of non-pharmacologicmodulation and combined trabeculectomy including trabeculectomy combinedwith cataract extraction add intraocular lens implantation and (or) adjustablesuture technique. Long-term and effectively control intraocular pressure(IOP)and protect visual function are the ultimate goal.Regular postoperative follow-up is very important for glaucoma patients.It should decrease fluctuation of IOP as far as possible,maintain IOP isrelatively low and stable level, which is necessary for the mitigation of theoptic nerve and visual function damage. some patients with ideal IOP, butvisual field impairment is still progress after surgery. so the treatment ofglaucoma is not only to control IOP within the normal range.It should findindividual target IOP and adjust the target IOP at any time based on visualfunction, The best level of IOP when the visual function without furtherdamage.It was a follow-up study on patients,eye condition after glaucomafiltering surgery,to evaluate the surgery effect and follow-up against the greenof this study was to evaluate the effect of surgery and follow-up is importantfor filtering surgery effect.Methods:We observed122(160eyes)patients,which accepted the filtration surgery and insisted on a regular Countercheck at the ophthalmologydepartment of the Second Hospital of Hebei Medical University, Among them,external filtering surgery69patients (88eyes), internal filteringsurgery(peripheral iridectomy surgery and1aser peripheral iridectomy, LPI)52patients (72eyes). Recorded their basic information of eachfollow-up,eyes condition: including visual acuity, IOP, filtrating bleb, cornea,anterior chamber, pupil, lens, or IOL and fundus, as well as visual field.According to surgical approach,external filteration surgery is divided intogroup A (conventional trabeculectomy), group B (trabeculectomy+mitomycinC), group C (cataract extraction+intraocular lens implantation+trabeculectomy), group D (cataract extraction with intraocularlensimplantation+trabeculectomy+mitomycin C+adjustable suture);internal filtdring surgery is divided into two groups:peripheral iridectomysurgery and LPI. Throuth observing the patient's visual acuity, intraocularpressure (IOP), filtering blebs,anterior chamber, lens or IOL and fundus, aswell as visual field, complications and follow-up compliance survey toevaluate the surgery effect.Results:1Patients of external filtering surgery were followed up for3to192months, with an average of45.13±51.95months. surgical success rate ofA, B, C and D was respectively77.78%,92.59%,79.17%,89.47%; Visualacuity of four groups were significantly higher than the preoperative, Amongthem,3eyes accepted the cataract extraction surgery in groupA;The IOP ofacute angle-closure glaucoma (ACG), chronic angle-closure glaucoma (CCG)and open-angle glaucoma (OCG) is lower than preperative, and the differenceswere statistically significant(p<0.05).The last follow-up IOP of group B waslowest (14.50±1.87mmHg) in ACG patients, surgical success rate of fourgroups was respectively71.43%,100%,83.33%,85.71%; The last follow-upIOP of group D was lowest (11.83±2.98mm Hg) in CCG patients, surgicalsuccess rate of four groups was respectively80%,75%,75%,91.67%; Thelast follow-up IOP of OCG was (12.79±3.71mmHg), the surgical successrate was92.86%. The differences were statistically significant (p<0.05).Maintenance of functional filtering blebs: group A and C(respectively50%,66.67%) was significantly lower than groupBand D(respectively85.19%,89.47%), At last follow-up, difference of functionalblebs and dysfunctional blebs was statistically significant; the percentage ofvisual field damage in progress was40%,36.36%,35%,18.75%respectivelyin four groups; the percentage of required medication to control IOP was14.29%,24%,31.58%,29.41%respectively in four groups.2Patients of internal filtering surgery were followed up for3to240months, with an average of38.85±50.91months. Surgical success rates ofperipheral iridectomy surgery and LPI were57.14%,90.77%; visual acuityof LPI improved significantly higher than peripheral iridectomy surgery at lastfollow-up,; surgical success rate of the two groups was50%,90.63%respectively in ACG patients,the differences of preperative and lastfollow-up IOP were statistically significant(p<0.05)in LPI; surgical successrate of the two groups was respectively60%,90.90%in CCG patients, thedifferences of preperative and last follow-up, IOP were statisticallysignificant(p<0.05)in two groups; the percentage of Visual field damage inprogress was83.33%,33.87%respectively in two groups; the percentage ofrequired medication to control IOP was50%,40.68%respectively in twogroups;3Preoperative and the last follow-up visual acuity was no significantdifference in patients; the surgical success rate of patients with good follow-upcompliance was significantly higher than that poor compliance, and thedifference was statistically significant.(p<0.05)Conclusions:1The condition success rate of filtering surgery is stillsatisfied, some patients needed anti-glaucoma drugs to control IOP aftersurgery in long-term.2It shoud be implemented external filtering surgery as early as possiblefor those patients with higher preoperative IOP.3Internal filtering surgery is relatively better for patients with smallperipheral synechia range and relatively shorter duration; Otherwise was poorer,4Bad follow-up compliance of patients with filtering surgery influencedthe surgery effect.5Patients with should adhere to long-term follow-up in order to promptlyfind and solve any problems, improving the surgery success rate,, thusimproving their life quality. Regular follow after filtering surgery canimprove the success rate of surgery, and protect the visual function therebyimprove quality of life of patients... |
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