CAJ | 학술논문

目的评价小梁切开术治疗原发性婴幼儿型青光眼的远期疗效及其相关影响因素.方法回顾性分析经过首次小梁切开术治疗的原发性婴幼儿型青光眼164例(257只眼)的术前基本情况,包括发病年龄、发病-手术时间、术前平均眼压、角膜透明度和角膜横径,并随访患儿的术后眼压;以术后眼压升高且使用1～2种局部降压药无效作为手术失败的标准.采用多元Logistic回归(Stepwise逐步回归法)分析筛选手术失败的危险因素,采用Cox回归(Stepwise逐步回归法)分析影响手术成功时间的相关因素及各时点手术成功率曲线的描记.结果中位数随访时间30.9(8.6～58.3)个月,随访率89.02%.多元Logistic回归分析得到术前眼压(P=0.047)和角膜透明度(P=0.019)为手术失败的危险因素,其比值比分别为ORIOP=1.408,ORCLA=1.691.Cox回归生存分析提示角膜透明度为与手术成功时间相关的因素(P=0.008),其比值比为ORCLA=1.632.结论角膜透明度较眼压值更稳定的反映了病情的轻重,术前角膜透明度评分联合眼压值可预测术后眼压控制效果.
목적 평개소량절개술치료원발성영유인형청광안적원기료효급기상관영향인소.방법 회고성분석경과수차소량절개술치료적원발성영유인형청광안164례(257지안)적술전기본정황,포괄발병년령、발병-수술시간、술전평균안압、각막투명도화각막횡경,병수방환인적술후안압;이술후안압승고차사용1～2충국부강압약무효작위수술실패적표준.채용다원Logistic회귀(Stepwise축보회귀법)분석사선수술실패적위험인소,채용Cox회귀(Stepwise축보회귀법)분석영향수술성공시간적상관인소급각시점수술성공솔곡선적묘기.결과 중위수수방시간30.9(8.6～58.3)개월,수방솔89.02%.다원Logistic회귀분석득도술전안압(P=0.047)화각막투명도(P=0.019)위수술실패적위험인소,기비치비분별위ORIOP=1.408,ORCLA=1.691.Cox회귀생존분석제시각막투명도위여수술성공시간상관적인소(P=0.008),기비치비위ORCLA=1.632.결론각막투명도교안압치경은정적반영료병정적경중,술전각막투명도평분연합안압치가예측술후안압공제효과.
Objective To study the relationship of long-term effect of trabeculotomy on primary congenital glaucoma and the related risk factors. Method 164 consecutive patients with primary congenital glaucoma (257 eyes), underwent initial surgery of trabeculotomy between 1996 and 2007. Follow-up was conducted for 30.9 (8.6-58. 3) months, with a follow-up rate of 89.02%. Multivariate analysis by Logistic regression was conducted to analyze the relation of the factors including age of onset, time between onset and operation, preoperative intraocular pressure, clarity of cornea, and comeal diameter to the failure of surgery. Cox proportional hazards regression modeling was used to analyze the factors related to success of surgery. Result Multivariate logistic regression showed that the preoperative intraocular pressure (IOP) and clarity of cornea were independent risk factors for final outcome ( ORIOP = 1. 408, P = 0.047, and ORCLA =1. 691, P =0. 019). Cox regression showed that clarity of cornea was the factor related to the surgery success time ( ORCLA = 1. 632, P = 0. 008 ) . Conclusion Clarity of cornea reflexes the condition of primary congenital glaucoma more stably than IOP. It is possible to prognosticate the surgical outcome to combine the clarity of cornea with the lOP value before operation.