准分子激光角膜屈光手术后开角型青光眼患者的临床特征

doi:10.3760/cma.j.cn115909-20200525-00220

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Abstract Objective: To observe the clinical characteristics of open-angle glaucoma patients with a history of refractive corneal ablation surgery (RCAS). Methods: This retrospective study reviewed and recorded the general situation and special examination results of open-angle glaucoma patients with a history of RCAS in Department of Ophthalmology, Peking University Third Hospital from 2005 to 2018. One eye of patients with a poorer visual field, or patients with a similar visual field was randomly selected for study. The patients who were followed up for more than 2 years were analyzed. NPA was used to analyze visual field progression. An independent samples test and rank sum test were used for analysis. Results: Thirty-three patients were included. The diagnosis of glaucoma was made after RCAS. The interval from surgery to glaucoma diagnosis was10.3±6.1 years. The age at diagnosis was 37.5±10.4 years. The highest intraocular pressure was less than 21 mmHg in 27 patients (82%). Central corneal thickness was 456±47 μm. Fundus photography showed a retinal nerve fiber layer defect in 18 patients (55%), unrecognized in 15 patients (45%); cup/disc ratio was 0.7±0.1. There were 18 patients (55%) with a visual field MD of less than 6, 8 patients (24%) of 6-12, and 7 cases (21%) of 12 or more. Twenty-one patients were followed up for more than 2 years with an average follow-up time of 4.5±2.2 years. There were 13 cases (62%) of visual field progression with an average rate of 0.5±0.6 dB/year. After treatment, the IOP in the visual field progressive group and the non-progressive group were 28.3%±20.7% and 15.4%±11.0%, respectively (t=-1.867, P=0.078). There were 12 cases (12/14) of visual field progression in the refractive regression group and 1 case (1/7) in the non-regression group (P=0.003). The visual field progression in the refractive regression group was 0.7±0.7 dB/year faster than that in the non-regression group 0.1±0.1 dB/year (t=-2.899, P=0.011). Conclusions: Most of the patients with glaucoma after excimer surgery were diagnosed in the early and middle stages of the disease. Four-fifths patients had an IOP below 21 mmHg. Fundus photography can identify only half of the cases of retinal nerve fiber layer defects. About two-thirds of patients with visual field deterioration during follow-up may be related to refractive regression.

Key words： glaucoma refractive corneal ablation surgery visual field refractive regression

Received: 25 May 2020

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Corresponding Authors: Lingling Wu, Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China (Email: wullc@hotmail.com)

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https://www.cjoovs.com/EN/10.3760/cma.j.cn115909-20200525-00220 OR https://www.cjoovs.com/EN/Y2020/V22/I9/665

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