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Trabeculectomy for Acute Primary Angle-Closure
隅角小樑切除術對急性原發性閉鎖性隅角的治療效果
摘要
目的：分析對急性原發性閉鎖性隅角病態，使用藥物治療且雷射虹膜穿孔術無效後，施行隅角小樑切除術的治療效果，並且評估手術中使用絲裂黴素C對預後是否有影響。方法：回溯性研究在西元1999年03月01日至西元2008年06月30日間，29位第一次發作急性原發性閉鎖性隅角之病患，之後接受隅角小樑切除術之效果。病患、在隅角小樑切除術後6個月內接受白內障手術者或是隅角小樑切除術後追蹤日期小於六個月者皆予以排除。手術預後及併發症皆被評估，包括術後2周、1、2、3、6、9、12個月的眼壓值。結果：最終眼壓測量小於21毫米汞柱並且沒有使用任何降眼壓藥物者有22位病患（75.9％）。最終眼壓測量小於21毫米汞柱但有使用降眼壓藥物者有3位病患（10.3％）。有4位病患（13.8％）需要進一步青光眼手術，被認定為失敗。手術中有使用絲裂黴素C者有8位病患（27.6％），手術中有、無使用絲裂黴素C，在之後追蹤的眼壓上並無統計學上的差異。全部病患只有一位病患術後產生前房塌陷的情況。結論：對急性原發性閉鎖性隅角病患，使用藥物治療及雷射虹膜穿孔術治療無效後，施行隅角小樑切除術的治療效果良好。
關鍵字
無資料並列摘要
Purpose: To analyze the results of trabeculectomy and the effect of anti-metabolites in cases of acute primary angle closure (APAC) with failed medical control and laser iridotomy. Method: In this study, 29 first-time APAC cases who received trabeculec-tomy between March 1, 1999 and June 30, 2008 were reviewed retrospectively. The cases that had cataract surgery within 6 months and a follow-up period of less than 6 months were excluded. The surgical outcome and complications were assessed according to the record including the intraocular pressure (IOP) at post-operative 2 weeks, and 1, 2, 3, 6, 9, and 12 months, as well as at the last visit to the clinic. Result: Final IOP was controlled to less than 21 mmHg without medications in 22 patients (75.9%). IOP was controlled to less than 21 mmHg with medication in 3 patients (10.3%). Four patients (13.8%) who required further glaucoma surgery were considered as failures. Mitomycin C (MMC) was used in 8 patients (27.6%). There was no significant difference between the MMC (+) group and the MMC (-) group in the mean IOPs at all follow-up months. Only one case encountered anterior chamber collapse (3.4%) Conclusion : Trabeculectomy has a favorable outcome in APAC with failed medical control and laser iridotomy.