Hepşen İbrahim F, Güler Emre, Kumova Deniz, Tenlik Aylin, Kulak Ali Ender, Hülya Yazici Eroğlu, Dişli Gaye
*Department of Ophthalmology, Gazi University, Medical School ‡Department of Ophthalmology, Turgut Özal University, Medical School, Ankara †Erciş State Hospital, Eye Clinic, Van, Turkey.
J Glaucoma. 2016 Jan;25(1):e29-34. doi: 10.1097/IJG.0000000000000214.
In this prospective study, we aimed to investigate the success and safety of a modified 360-degree suture trabeculotomy (ST) technique in patients with pseudoexfoliation glaucoma (XFG).
The modified 360-degree ST was performed on 15 eyes of 15 patients with XFG resistant to maximal topical treatment. In 6 patients, ST was combined with phacoemulsification. Main outcome measures were the surgical success rate, mean postoperative intraocular pressure (IOP), the number of antiglaucoma medications, and the operative complications.
The mean follow-up period was 8 months (range 6 to 12 mo). Baseline IOP decreased from 27.53±9.38 mm Hg on 3.26±0.70 medications to 12.86±2.72 mm Hg (P=0.01) on 0.20±0.56 medications (P=0.01) at 6 months postoperatively accounting for a 52.82% reduction. The complete and qualified success rates were 77% and 100%, respectively, at the sixth month. The entire circumference of the Schlemm canal was successfully opened in all cases. Hyphema (in all cases), intraoperative iris prolapse (in 3 cases), transient elevation of the IOP (in 1 case), posterior synechia (in 2 phakic cases), and peripheral anterior synechia (in 1 case) were noted. There was not a trend for lower IOP after combined phacomodified 360-degree ST in this small group.
The modified 360-degree ST appears to be a valuable option for the surgical treatment of XFG. Future studies are needed to explore the remote side effects and the long-term effects of this procedure on IOP.
在这项前瞻性研究中，我们旨在调查改良的360度小梁切开术（ST）技术在假性剥脱性青光眼（XFG）患者中的成功率和安全性。
对15例经最大程度局部治疗仍耐药的XFG患者的15只眼进行改良的360度ST。6例患者中，ST与超声乳化术联合进行。主要观察指标为手术成功率、术后平均眼压（IOP）、抗青光眼药物数量及手术并发症。
平均随访期为8个月（范围6至12个月）。术后6个月时，基线眼压从使用3.26±0.70种药物时的27.53±9.38 mmHg降至使用0.20±0.56种药物时的12.86±2.72 mmHg（P = 0.01），降低了52.82%。第六个月时，完全成功率和合格成功率分别为77%和100%。所有病例中施莱姆管的整个圆周均成功打开。观察到前房积血（所有病例）、术中虹膜脱垂（3例）、眼压短暂升高（1例）、后粘连（2例有晶状体眼病例）和周边前粘连（1例）。在这个小样本中，联合超声乳化改良360度ST后眼压没有降低的趋势。
改良的360度ST似乎是XFG手术治疗的一个有价值的选择。需要进一步研究来探索该手术的远期副作用及其对眼压的长期影响。
