Grieshaber Matthias C, Schoetzau Andreas, Grieshaber Hans R, Stegmann Robert
Department of Ophthalmology, Sefako Makgatho Health Sciences University (former Medical University of Southern Africa); Medunsa, Pretoria, South Africa.
Department of Ophthalmology, University of Basel, Basel, Switzerland.
Acta Ophthalmol. 2017 Aug;95(5):503-508. doi: 10.1111/aos.13372. Epub 2017 Jan 13.
To examine longer-term postsurgical safety and efficacy of a new expander for Schlemm's canal.
In a non-comparative, prospective study, 42 White patients with medically uncontrolled primary open-angle glaucoma (POAG) underwent primary canaloplasty with >2-year follow-up. The bleb-independent procedure comprised catheter-assisted canaloplasty and implantation of two Stegmann Canal Expanders to maintain trabecular distension and canal patency over 180°. Intraocular pressure (IOP), glaucoma medication use and complications were assessed.
Mean IOP was 26.8 ± 5.6 mmHg presurgery, 12.8 ± 1.5 mmHg at 6 months, 13.2 ± 1.2 mmHg at 12 months and 13.3 ± 2.5 mmHg at 24 months (p < 0.001). Rate of complete success, defined as IOP ≤21, ≤18 and ≤16 mmHg and a ≥ 30% IOP reduction, was 85% (95% CI: 0.76-0.95), 85% (0.76-0.95) and 82% (0.70-0.96) at 12 months and 83% (0.73-0.94), 80% (0.70-0.92) and 80% (0.70-0.92) at 24 months. Preoperative factors were not significant predictors of ≤16 mmHg IOP reduction: IOP (hazard ratio [HR]: 0.68; 95% CI: 0.44-1.04; p = 0.08), mean visual defect (1.06; 0.90-1.20; p = 0.47), number of medications (0.59; 0.17-2.14; p = 0.42) and age (0.96; 0.87-1.13; p = 0.41). Number of medications dropped from 2.8 ± 0.4 presurgery to 0.2 ± 0.5 postsurgery (p < 0.001). Mean preoperative best-corrected visual acuity was 0.19 ± SD 0.21 (range: 0-1.6), and logMAR was similar to 0.23 ± 0.16 (range: 0-1.6; p = 0.42) after a mean follow-up of 27.4 months. Complications included peripheral Descemet's membrane detachment (7.2%) and trimming of the expander (4.7%) during surgery, and transient microhyphaema (23.8%) and IOP elevation (7.2%) postsurgery.
Canaloplasty with the Stegmann Canal Expander was a safe and effective procedure to reduce IOP in White patients with moderate to advanced POAG.
研究一种用于施累姆氏管的新型扩张器的长期术后安全性和有效性。
在一项非对比性前瞻性研究中，42例药物治疗无法控制的原发性开角型青光眼（POAG）白人患者接受了原发性睫状体成形术，并进行了超过2年的随访。不依赖于滤过泡的手术包括导管辅助睫状体成形术和植入两个施特格曼管扩张器，以维持小梁扩张和180°范围内的管腔通畅。评估了眼压（IOP）、青光眼药物使用情况和并发症。
术前平均眼压为26.8±5.6 mmHg，6个月时为12.8±1.5 mmHg，12个月时为13.2±1.2 mmHg，24个月时为13.3±2.5 mmHg（p<0.001）。完全成功的比率定义为眼压≤21、≤18和≤16 mmHg且眼压降低≥30%，12个月时分别为85%（95%CI：0.76 - 0.95）、85%（0.76 - 0.95）和82%（0.70 - 0.96），24个月时分别为83%（0.73 - 0.94）、80%（0.70 - 0.92）和80%（0.70 - 0.92）。术前因素不是眼压降低≤16 mmHg的显著预测因素：眼压（风险比[HR]：0.68；95%CI：0.44 - 1.04；p = 0.08）、平均视野缺损（1.06；0.90 - 1.20；p = 0.47）、药物数量（0.59；0.17 - 2.14；p = 0.42）和年龄（0.96；0.87 - 1.13；p = 0.41）。药物数量从术前的2.8±0.4降至术后的0.2±0.5（p<0.001）。术前平均最佳矫正视力为0.19±标准差0.21（范围：0 - 1.6），平均随访27.4个月后，最小分辨角对数视力与0.23±0.16相似（范围：0 - 1.6；p = 0.42）。并发症包括手术期间周边Descemet膜脱离（7.2%）和扩张器修剪（4.7%），以及术后短暂性微前房积血（23.8%）和眼压升高（7.2%）。
对于中度至重度POAG白人患者，使用施特格曼管扩张器进行睫状体成形术是一种降低眼压的安全有效的手术。
