ผลและภาวะแทรกซ้อนหลังการผ่าตัดรักษาต้อหินในผู้ป่วยต้อหินชนิดความดันลูกตาปกติ

บทคัดย่อ

          Purpose : To evaluate the efficacy and complications after trabeculectomy with mitomycin C (MMC) in Japanese normal tension glaucoma (NTG) patients using the Kaplan-Meier life table method.

          Methods : Clinical records of 39 NTG patients who underwent trabeculectomy with 0.04% MMC and having postoperative follow-up period of 4 years or more were retrospectively reviewed. Postoperative IOP at every 1 or 2 months, complications, visual acuity, and visual field at every 6 months were recorded.

          Results : IOP significantly decreased from 15.9 ± 1.9 (mean ± S.D.) preoperatively to 8~11 mmHg throughout the postoperative follow-up penod (P < 0.0001). The life table analysis in which failures of IOP control was defined as when lOPs exceeding 30% or 20% lower than the preoperative IOP were obtained for 3 consecutive visits showed the cumulative survival rate of 39.4 ± 7.8% (mean ± SEM) or 41.3 ± 8.9%, respectively at 4 years after surgery. Mean deviation of the visual field results did not significantly change (P > 0.5). The cumulative survival rate from postoperative hypotony were 74.7 ± 6.3% at 4 years after surgery. Postoperative complications obsenred were shallow anterior chamber (6 eyes), choroidal detachment (9 eyes), hypotonous maculopathy (7 eyes), bleb leak (1 eye), cataract development (3 eyes), and blebitis (2 eyes). No eyes developed endophthalmitis.

          Conclusions : In NTG patients, trabeculectomy with MMC showed significant IOP reducing efficacy up to 4 years after surgery. Since risks of postoperative complications are unavoidable, the indication of the surgery should be carefully decided and careful follow up is necessary to avoid severe postoperative complications.