Abstract
Background:To compare the efficacy of Ex-PRESS implantation versus trabeculectomy combined with phacoemulsification.Methods:A retrospective 12-month study on patients with coincident primary open-angle glaucoma(POAG)and cataract.The patients underwent combined phacoemulsification and Ex-PRESS implant(Phaco-ExPRESS,n=35)or phacotrabeculectomy(Phaco-Trab,n=35).The morphological structures of the filtering bleb were examined by slit-lamp,anterior segment optical coherence tomography(AS-OCT)and in vivo confocal microscopy(IVCM).Complete success was defined as postoperative intraocular pressure(IOP)＜18 mmHg without the use of anti-glaucoma medi-cation.Qualified success was defined as postoperative IOP＜18 mmHg with or without anti-glaucoma medications.The data were collected preoperatively and postoperatively at 2 weeks,1 month,3 months,6 months,and 12 months.Results:No significant difference in the variables such as age,IOP and perimetry was found between the groups of Phaco-ExPRESS and Phaco-Trab.At the one-year postoperative visit for filtering blebs,Phaco-ExPRESS increased the mean area of epithelial microcysts significantly from 0.10±0.05 to 0.20±0.09 μm2 per μm2,while Phaco-Trab decreased the mean area significantly from 0.08±0.04 to 0.04±0.06 μm2 per μm2.Notably,the hyperreflective dots detected by IVCM decreased by 84.9％in Phaco-ExPRESS but increased by 36.3％in Phaco-Trab.The hyperreflective dots were further identified as neutrophil-and monocyte-like cells.The number of these cells were negatively corre-lated with the microcysts area(r=-0.7,P＜0.01)but positively associated with the grade of connective tissue(r=0.5,P＜0.01).By creating different microstructural changes in the filtering blebs,Phaco-ExPRESS produced a higher com-plete success rate(84.9％vs.41.2％,P＜0.01)and significant decrease in the number of anti-glaucoma medications(P＜0.01)when compared with those in Phaco-Trab.However,the qualified success showed no significant difference between the two groups(100.0％vs.91.2％,P=0.24).Conclusions:At the one-year follow-up,Phaco-ExPRESS generated better filtering bleb with larger area of micro-cysts,looser connective tissues,and less inflammation than that of Phaco-Trab,providing adequate IOP control and less IOP-lowering medications.These findings indicate that Phaco-ExPRESS could be more preferred than Phaco-Trab for the treatment of patients with coincident POAG and cataract.
基金项目
广东省自然科学基金(2018A030313833)
广东省自然科学基金(2020A1515010103)
National Natural Science Foundation Incubation Program of Guangdong Provincial People's Hospital(KY01201147)
National Natural Science Foundation Incubation Program of Guangdong Provincial People's Hospital(KY01201146)
NETL
NSTL
万方数据