邯郸地区原发性闭角型青光眼手术患者的远期随访状况调查  

A retrospective survey of long-term follow-up on primary angle closure glaucoma after trabeculectomy

作　　者：刘昆[1,2] 荣世松[1] 梁远波[1] 范肃洁[3] 刘文茹[3] 孙霞[1] 孙兰萍[3] 王宁利[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室,100730 [2]首都医科大学附属安贞医院 [3]河北邯郸市眼科医院

出　　处：《眼科》2011年第1期50-54,共5页Ophthalmology in China

基　　金：国家科技部十五科技攻关计划(2003BA712A11-18);国家科技部十一五科技支撑计划(2007BAI18B08)

摘　　要：目的了解邯郸地区原发性闭角型青光眼(PACG)患者小梁切除术后的随访状况及影响随访的可能因素。设计回顾性病例系列。研究对象河北省邯郸市眼科医院2002年5月-2005年5月的PACG小梁切除术患者410例。方法采用电话、通信等方式通知患者于2006年5-8月回邯郸眼科医院复诊。复诊时详细询问手术后患者的自然随访情况,包括随访频率、日期、用药依从性等,并进行眼科检查,包括矫正视力、裂隙灯、视野及眼底检查,同时进行青光眼认知情况问卷调查。主要指标随访率及调查问卷情况。结果 410份病例中,126例(47.9%)可电话联系到本人,按约复查56例,根据病历中记录的地址发信,按约6例(15.1%)来院复查。62例复查患者中,男性22例,平均年龄(63.5±9.1)岁;复诊时眼压高于21mm Hg 11例(17.7%);最佳矫正视力<0.3者22例(35.5%);平均视野缺损值(-13.1±10.5)dB。术后1、6个月、1、4年的随访率分别为84.4%、41.1%、21.3%、13.3%。Logistic回归分析显示,影响随访率的主要因素是青光眼认知情况(P<0.05)。结论邯郸地区PACG患者小梁切除术后远期随访率较低,4年随访率仅13%,这与对青光眼的认知较差有关。推测我国有相当数量的滤过术后患者不能坚持长期随访,应引起眼科医生的高度重视。Objective To reveal the current longitudinal follow-up rate after trabeculectomy in cases of primary angle closure glaucoma（PACG） in Handan City,China.Some possible determinants of follow-up rate were discussed.Design Retrospective case series.Participants Four hundred and ten PACG patients who received trabeculectomy from May,2002 to May,2005 at Handan Eye Hospital.Method All of the enrolled patients were followed up to return to the hospital for eye check-up by means of telephone and correspondence.During the visit,questionnaire concerning the dates,frequencies of the postoperative follow-up visits,compliance and knowledge about glaucoma was administered.Further eye examinations such as best corrected visual acuity,slitlamp,visual field and fundus examination were conducted.Main Outcome Measures Follow-up rate and results from the questionnaire.Result Among 410 cases,126（47.9%） patients successfully received phone calls,56 returned.Additional 145 letters were sent,six returned.Totally,sixty two（15.1%） patients returned to the hospital,22 males,mean age of years 63.5±9.1.The number of patients with IOP more than 21mm Hg was 11（17.7%）,with best corrected visual acuity 0.3 was 22（35.5%）,mean MD was-13.1±10.5.The follow-up rate at 1,6,12 and 48 months after trabeculectomy was 84.4%,41.1%,21.3% and 13.3%,respectively.Logistic regression analysis showed that knowledge about glaucoma（P0.05）,farmer（P=0.002） and low vision（P=0.001） were determinant of follow up rate.Conclusion PACG patients after trabeculectomy have a poor long term follow-up rate in Handan（10% at 4th year）.It is extrapolated that a considerable amount of PACG patients could not be compliant with long term follow-up requirement.Measures should be taken to make the patients,doctors and the society aware of this situation.

关 键 词：闭角型青光眼 问卷调查 小梁切除术 

分 类 号：R779.6[医药卫生—眼科]