Smith Brett L, Ellyson Austin C, Kim Won I
Department of Ophthalmology, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20901.
Mil Med. 2018 Mar 1;183(suppl_1):146-149. doi: 10.1093/milmed/usx174.
To introduce a trabectome-initiated gonioscopy-assisted transluminal trabeculotomy (TIGATT) procedure and to report preliminary results.
A preliminary case series of eight patients who have undergone the newly proposed TIGATT procedure is presented. TIGATT is a new concept that modifies established techniques by replacing the initial goniotomy incision of gonioscopy-assisted transluminal trabeculotomy (GATT) with an ab interno trabeculectomy ablation utilizing the trabectome. All surgeries were performed by a single surgeon (W.I.K.) between November 2014 and October 2015 in adults with primary open-angle glaucoma. Recorded outcome measures were intraocular pressure (IOP), number of medications, and complications.
Eight patients with an age range of 63-93 yr underwent TIGATT with at least 3 mo of follow-up. Five of the eight initial patients had follow-up to 2 yr. The mean pre-operative IOP was 25 mmHg (standard deviation [SD] 7.0) on four medications (SD 1.1). The mean post-operative IOP at 3 mo was 14 mmHg (SD 1.8) on two medications (SD 1.3). The average decrease in IOP was 9.9 mmHg (SD 7.5) with an average decrease in medications of two (SD 1.4) at 3 mo. At 2 yr, the mean post-operative IOP was 14 mmHg (SD 3.2) on one medication (SD 1.1). The average decrease in IOP was 7.8 mmHg (SD 3.1) with an average decrease in medications of two (SD 1.8). There were two treatment failures that required further glaucoma surgery and one patient was lost to follow-up.
The preliminary results and safety profile for TIGATT are promising and appear at least comparable with previously published results for both GATT and trabectome. Initiating the transluminal trabeculotomy with trabectome clearly exposes Schlemm's canal and facilitates threading the microcatheter into the canal. Additionally, if the 360-degree trabeculotomy cannot be completed because of an incompletely patent Schlemm's canal, the patient will at least have a trabectome ablation that can serve as their glaucoma surgery.
介绍小梁切开刀启动的房角镜辅助小梁切开术（TIGATT）并报告初步结果。
呈现了一组8例接受新提出的TIGATT手术患者的初步病例系列。TIGATT是一个新概念，它通过使用小梁切开刀进行内路小梁切除术消融来替代房角镜辅助小梁切开术（GATT）最初的房角切开切口，从而对现有技术进行了改良。所有手术均由同一位外科医生（W.I.K.）于2014年11月至2015年10月期间在患有原发性开角型青光眼的成年人中进行。记录的结果指标包括眼压（IOP）、用药数量和并发症。
8例年龄在63 - 93岁的患者接受了TIGATT手术，且至少随访了3个月。8例初始患者中有5例随访至2年。术前平均眼压为25 mmHg（标准差[SD] 7.0），使用4种药物（SD 1.1）。术后3个月时平均眼压为14 mmHg（SD 1.8），使用2种药物（SD 1.3）。3个月时眼压平均降低9.9 mmHg（SD 7.5），用药平均减少2种（SD 1.4）。在2年时，术后平均眼压为14 mmHg（SD 3.2），使用1种药物（SD 1.1）。眼压平均降低7.8 mmHg（SD 3.1），用药平均减少2种（SD 1.8）。有2例治疗失败需要进一步的青光眼手术，1例患者失访。
TIGATT的初步结果和安全性令人鼓舞，至少与先前发表的GATT和小梁切开刀的结果相当。用小梁切开刀启动小梁切开术能清晰暴露施莱姆管，并便于将微导管插入该管。此外，如果由于施莱姆管不完全通畅而无法完成360度小梁切开术，患者至少进行了小梁切开刀消融术，可作为其青光眼手术。
