| Abstract | Cilj istraživanja:
Cilj ove studije jest je usporediti učinkovitost trabekulektomije i duboke sklerektomije u snižavanju očnog tlaka, te učinak na vidnu oštrinu. Također, želimo istražiti kolika je zastupljenost pojedinih operacija prema spolu i dobi.
Ustroj istraživanja:
Ova studija je povijesno-prospektivna studija.
Mjesto istraživanja:
Studija se odvijala na Klinici za očne bolesti, Kliničkog bolničkog centra, Split.
Sudionici:
Pacijenti podvrgnuti trabekulektomiji ili dubokoj sklerektomiji zbog dekompenziranog primarnog glaukoma otvorenog kuta u razdoblju od 1. siječnja 2010. do lipnja 2012. godine. Od ukupno 106 pacijenata 87 je podvrgnuto operaciji; trabekulektomiji njih 48, a dubokoj sklerektomij 39. U skupini pacijenata podvrgnutih trabekulektomiji od ukupno 48 pacijenata bilo je 26 (54%) muškaraca i 22 (46%) žena. Od ukupno 39 pacijenata, bilo je 18 (46%) muškaraca i 21 (54%) žena. U skupini od 48 pacijenata operiranih trabekulektomijom njih 39 je imalo uspješnu operaciju, odnosno 81.25%, dok je kod duboke sklerektomije od ukupno 39 pacijenata njih 33 imalo uspješnu operaciju odnosno 84.62%.
Glavne mjere ishoda:
Usporedba učinkovitosti operacijskih tehnika. Učinkovitost operacije procijenjivala se na temelju visine očnoga tlaka. Normalna visina intraokularnog tlaka kreće se između 11 i 21 mmHg, a najbolja je srednja vrijednost od 14-16mmHg. Uspješnija je operacijska tehnika kojom se postigao niži očni tlak i bolji nalaz vidnoga polja te bolje vrijednosti vidne oštrine.
Rezultati:
Provedena je povijesno-prospektivna studija u kojoj je sudjelovalo 87 ispitanika u dobi između 40 i 90 godina, od toga 44 muškarca i 43 žene. Ako promatramo odnos operiranih prema spolu vidimo da je podjednaka zastupljenost muškaraca i žena u obje operacije. Testom razlike dviju proporcija, budući da je P>0.05 nije uočena statistički značajna razlika između ovih vrijednosti. Ako uspješnost promatranih tehnika operacija mjerimo postotkom broja bolesnika kod kojih se tlak smanjio, možemo zaključiti slijedeće: od ukupno 48 pacijenata operiranih trabekulektomijom njih 39 je imalo uspješnu operaciju, odnosno 81.25%, dok je kod duboke sklerektomije od ukupno 39 pacijenata njih 33 imalo uspješnu operaciju odnosno 84.62%. Premo tome duboka sklerektomija je uspješnija metoda snižavanja intraokularnog tlaka. Međutim testom razlike dviju proporcija nije nađena statistički značajna razlika. Uspoređivanjem broja pacijenata sa tlakom manjim od 22 mmHg nakon operacije (neovisno o razini tlaka prije operacije). Kod trabekulektomije, ta je proporcija 95.8% (46/48), a kod duboke sklerektomije 97.43% (38/39). P<0.05, dakle, obje tehnike značajno snizuju intraokularni tlak. Uspješnost promatranih tehnika operacija trabekulektomije i duboke sklerektomije se mjeri postotkom broja pacijenata kod kojih se nalaz vidna oštrine poboljšao nakon operacije. Kod trabekulektomije od ukupno 48 pacijenata njih 8 je imalo uspješnu operaciju, odnosno 16.67%, dok je kod duboke sklerektomije od ukupno 39 pacijenata njih 5 imalo uspješnu operaciju, odnosno 12.82%. Premo tome trabekulektomija je uspješnija ako uzimamo u obzir nalaz vidne oštrine nakon operacije. Međutim, testom razlike dviju proporcija nije nađena statistički značajna razlika jer je P>0.05.
Zaključci:
Obje operacijske tehnike statistički značajno smanjuju očni tlak, ali ne poboljšavaju vidnu oštrinu. Trabekulektomija nema statističi značajno smanjenje očnog tlaka nakon operacije u usporedbi s dubokom sklerektomijom. Također, nije uočeno statistički značajne razlike između pacijenata operiranih trabekulektomijom u odnosu na operirane dubokom sklerektomije prema spolu, ni dobi. |
| Abstract (english) | Objective:
The aim of this study is to compare the effectiveness of trabeculectomy and deep sclerectomy in lowering intraocular pressure and the effect on visual acuity. Also, it is desired to study age and gender distribution in individual operations.
Study design:
This study is a historical prospective study.
Place of research:
The study was conducted in the Ophthalmology Clinic in the Clinical Hospital Centre in Split.
Participants:
Patients who underwent trabeculectomy or deep sclerectomy for decompensated primary open angle glaucoma in the period from 1st of January 2010 to June 2012. From a total of 106 patients 87 underwent the operation; 48 of them underwent trabeculectomy and 39 of them underwent the deep sclerectomy. In the group of patients who underwent the trabeculectomy from overall 48 patients there was 26 (54%) of man and 22 (46%) women. From a total of 39 patients 18 (46%) of them were man and 21 (54%) of them were women. In a group of 48 patients who have had a trabeculectomy surgery, 39 of them (81.25%) had a successful surgery while from a total of 39 patients who underwent a deep sclerectomy 33 of them (86.62%) had a successful surgery.
Primary efficacy:
The comparison of the effectiveness of the surgical methods. The effectiveness of the surgery was estimated based on how high is the intraocular pressure of the patient. The normal value of the intraocular pressure is between 11 and 21 mmHg and the best average value is from 14 to 16 mmHg. The method that has achieved lowest intraocular pressure, better finding of the visual field and better values of the visual acuity was found to be better.
Results:
A historical prospective study in which 87 participants aged between 40 and 90 years was conducted. The male- female ratio was 44 man and 43 womenIf gender ratio of patients who underwent the surgery was studies it can be seen that there is an equal presence of man and women in both operations. After difference test was carried out it was found that P>0.05 and therefore there was no statistically significant difference observed between those who values. If, however, the success of the studied surgical methods is measured based on the number of patients whose pressure was reduced, the following can be drawn: from total of 48 patients who underwent the trabeculectomy 39 (81.25%) of them had a successful surgery while from a total of 39 patients who underwent a deep sclerectomy 33 (86.62%) of them had a successful surgery. Therefore, deep sclerectomy is a more successful method for lowering the intraocular pressure. However, when difference test was conducted there was no statistically significant difference found. Comparing the number of patients with the pressure lower than 22 mmHg after the surgery (independent of their pressure before the surgery). In trabeculectomy the proportion is 95.8 % (46/48) while in deep sclerectomy the proportion is 97.43 % (38/39). P<0.05 and therefore both methods significantly reduce the intraocular pressure. The success of the studied methods of trabeculectomy and deep sclerectomy surgeries is measured by the percentage of the number of patients whose finding of the visual acuity was improved after the surgery. With trabeculectomy from the total of 48 patients 8 (16.67%) of them had a successful surgery while with deep sclerectomy from the total of 39 patients 5 (12.82%) of them had a successful operation. Therefore, trabeculectomy i more successful method if the success is measured based on the findings of the visual acuity after the surgery. However, when difference test was conducted there was no statistically significant difference found because P> 0.05.
Conclusions:
Both surgical methods statistically significantly lower intraocular pressure but do not improve the visual acuity. Trabeculectomy has no statistically significant reduction of the intraocular pressure after the operation when compared to the deep scelectromy. Furthermore, there was no statistically significant difference observed between the patients who underwent trabeculectomy and those who underwent the deep scelectromy regarding age and gender. |
