口服弥可保对晚期青光眼术后视野及RNFL厚度的影响

摘要

目的:观察和评价口服弥可保对晚期青光眼患者小梁切除术后视野及视网膜神经纤维层(retinal nerve fiber layer,RNFL)厚度的影响.方法:回顾性系列病例研究.收集57例57眼经过手术治疗后解除高眼压状态的晚期青光眼患者,随机分为对照组29例29眼和治疗组28例28眼,对照组患者常规抗青光眼治疗,治疗组患者在对照组基础上口服弥可保6mo,3次/d,500μg/次.分别于出院时,出院后6mo应用Humphrey 750i型视野计检测视野平均缺损及视野模式标准差;应用Stratus OCT-3仪(Carl Zeiss Meditec,Dublin,CA) 检测平均和各个区域的RNFL厚度.两组间检查指标比较采用独立样本t检验.结果:出院后6mo,视野平均缺损:治疗组-13.30±4.03dB,对照组-18.51±4.33dB,两组比较差异有统计学意义(t= -2.112,P=0.049);视野模式标准差:治疗组为5.64±0.48dB,对照组为8.21±2.47dB,两组比较差异有统计学意义(t=-2.436,P=0.025);RNFL厚度:全周:治疗组75.828±7.260μm,对照组65.037±13.074μm,两组间差异有统计学意义(t=-2.282,P=0.035).结论:晚期青光眼术后患者长期口服弥可保可对青光眼所致的视野缺损及视网膜神经纤维丢失有明显改善.%AIM: To evaluate the effectiveness of Mecobalamin on the visual field and retinal nerve fiber layer (RNFL) thickness in patients with advanced glaucoma after trabeculectomy.METHODS: This was a retrospective observational case series. We chosed 57 cases (57 eyes) operated, whose high intraocular pressure had been relieved after trabeculectomy. Patients were randomly selected and divided into treatment group 28 cases (28 eyes), and control group 29 cases (29 eyes) (conventional treatment group). The treatment group received both conventional therapy and Mecobalamin 500μg, 3 times a day for 6 months. The mean defect (MD) and pattern standard deviation(PSD) were strictly measured by Humphrey 750i and the total and regional mean RNFL thickness were measured using a Stratus OCT-3(Carl Zeiss Meditec, Dublin, CA) at the time of discharge from hospital and at 6 months. Independent - samples f test was used to compare the results obtained from these two groups.RESULTS: At 6 months, MD: treatment group( -13.30± 4.03)dB, control group(-18.51±4.33)dB, PSD: treatment group(5. 64 ±0. 48) dB, control group ( 8. 21 ± 2. 47 ) dB. There were statistically significant differences (t =-2.112, P=0.049; t =-2.436, P= 0.025) in MD and PSD between the two groups. And the RNFL thickness overall: treatment group(75.828±7. 260) μm,control group(65. 037± 13. 074) μm, RNFL thickness of the nasal quadrant:treatment group (59. 077 ± 11. 055) μm, control group (48.122 ±7. 385) μm, RNFL thickness of the temporal quadrant: treatment group(61. 098±14. 832) μm, control group(48.133+17.174)pm, RNFL thickness of the superior quadrant: treatment group(96. 263±22. 537) μm, control group(85.596±20.472)pm, RNFL thickness of the inferior quadrant: treatment group (94. 821 ± 19. 693 ) μm, control group ( 85. 072 ± 23. 384) μm. There were statistically significant differences in all Stratus OCT-3 measurement parameters(t=-2.282, P=0.035; t=-2.182, P=0.043; t=-2.589, P=0.019; t=-2.236, P=0.038; t=-2.295, P=0.034).CONCLUSION: Long-term oral Mecobalamin administration obviously improves the visual field defect and retinal nerve fibers loss in the patients with advanced glaucoma after trabeculectomy.