非穿透小梁手术的术后早期并发症及成本-效果分析

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目的评价非穿透小梁手术(NPTS)的术后早期并发症及成本效果。方法回顾性分析147例(215只眼)原发性开角型青光眼患者行滤过性手术后的临床资料,包括早期(住院期间)视力、眼压及并发症发生情况。其中NPTS组104只眼,改良小梁切除术(MT)组111只眼。根据所需治疗的例数(NNT)和手术效果,对预防不良事件的发生进行成本效果分析。结果(1)早期视力波动:术后视力下降两行以上者NPTS组25只眼(24.0%)、MT组26只眼(23.4%),两组间的视力变化差异无统计学意义(P>0.05)。(2)早期低眼压:术后第1天眼压≤5mmHg(1mmHg=0.133kPa)者NPTS组39只眼(38.2%),MT组10只眼(9.2%),两组间差异有统计学意义(P<0.01);出院时眼压≤5mmHg者分别为18只眼(27.5%)和19只眼(17.3%),两组间差异有统计学意义(P<0.05)。(3)前房出血:NPTS组20只眼(19.2%),MT组10只眼(9.0%);各组均有2只眼需行前房冲洗;两组间前房出血发生率的差异有统计学意义(P<0.05)。(4)早期浅前房:NPTS组发生Ⅱ°浅前房2只眼,Ⅰ°浅前房5只眼;MT组Ⅱ°浅前房5只眼,Ⅰ°浅前房5只眼;各组均未出现Ⅲ°浅前房者,两组间不同程度浅前房的发生率差异无统计学意义(P>0.05)。(5)其他并发症:NPTS组术中小梁穿透1只眼,遂改行小梁切除术;术后瞳孔散大6只眼;急性眼压升高1只眼;内滤口虹膜前粘连1只眼;低眼压性黄斑水肿1只眼。(6)成本效果分析:NPTS组对不良事件的绝对风险降低率(ARR)=3.0%,防止1例不良事件发生需治疗的病例数(NNT)=33.2例,较MT组多花费成本11.6万元;对于严重不良事件,NPTS组的绝对风险降低率=1.8%,NNT=55.5例,较MT组多花费成本19.4万元。结论NPTS可能在减少抗青光眼术后严重不良事件的发生方面具有一定作用,但与MT相比,其在减少并发症方面的成本较高;因此,基层医院眼科医师应重点掌握MT操作技术。 Objective To evaluate the early postoperative complications and cost-effectiveness of non-penetrating trabecular surgery (NPTS). Methods The clinical data of 147 cases (215 eyes) with primary open-angle glaucoma after retrograde surgery were analyzed retrospectively. The results included early (in-hospital) vision, intraocular pressure (IOP) and complications. Among them, 104 eyes of NPTS group and 111 eyes of modified trabeculectomy group (MT). Based on the number of cases to be treated (NNT) and the effect of the surgery, a cost-effectiveness analysis was performed on the prevention of the occurrence of adverse events. Results (1) Early visual acuity (VAS): There were 25 eyes (24.0%) in NPTS group and 26 eyes (23.4%) in MT group after operation. There was no significant difference in visual acuity between the two groups (P> 0.05). (2) Early low intraocular pressure: 39 eyes (38.2%) in NPTS group and 10 eyes (9.2%) in MT group had intraocular pressure less than or equal to 5mmHg (1mmHg = 0.133kPa) on the first postoperative day. There was statistical difference between the two groups (P <0.01). There were 18 eyes (27.5%) and 19 eyes (17.3%) with IOP ≤5mmHg at discharge, respectively. There was significant difference between the two groups (P <0.05). (3) Anterior chamber hemorrhage: 20 eyes (19.2%) in NPTS group and 10 eyes (9.0%) in MT group. There were 2 eyes in each group needed to wash in the anterior chamber. The incidence of hyphema There was statistical significance (P <0.05). (4) Early shallow anterior chamber: There were 2 eyes with shallow anterior chamber Ⅱ and 5 eyes with shallow anterior chamber Ⅰ in NPTS group, 5 eyes with shallow anterior chamber Ⅱ and 5 eyes with shallow forearm Ⅰ in MT group Ⅲ ° shallow anterior chamber were not seen in any group. There was no significant difference in the incidence of shallow anterior chamber between the two groups (P> 0.05). (5) other complications: NPTS group trabecular bone penetrating an eye, then switch to trabeculectomy; postoperative mydriasis 6 eyes; acute intraocular pressure increased 1 eye; filter within the iris anterior adhesions 1 Only eye; IOP macular edema 1 eye. (6) Cost-effectiveness analysis: The absolute risk reduction rate (ARR) for NPTS group was 3.0%, and the number of cases to be treated to prevent one adverse event (NNT) was 33.2 cases, which cost 116,000 more than the MT group For the serious adverse events, the absolute risk reduction rate of NPTS group was 1.8% and NNT was 55.5, which cost 194000 yuan more than MT group. Conclusions NPTS may play a role in reducing the incidence of serious adverse events after anti-glaucoma surgery. However, compared with MT, NPTS may have a higher cost in reducing complications. Therefore, ophthalmologists in grassroots hospitals should master the MT technique.
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