Department of Ophthalmology, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust.
Department of Ophthalmology, Queen Mary's Hospital, King's College Hospital NHS Foundation Trust, London, UK.
J Glaucoma. 2020 Jan;29(1):53-59. doi: 10.1097/IJG.0000000000001403.
The objective of this study was to report medium-term outcomes of a novel combination of phacoemulsification with transscleral cyclophotocoagulation (phaco-TCP) compared with combined phacoemulsification and endoscopic cyclophotocoagulation (phaco-ECP) in patients with uncontrolled or suboptimally controlled glaucoma and coexisting cataract.
Retrospective case series of 80 consecutive patients with a minimum of 12 months of follow-up. In total, 46 eyes underwent phaco-ECP and 34 phaco-TCP. Success was defined as intraocular pressure (IOP) between 6 and 21 mm Hg with ≥20% reduction from preoperative IOP (with no increase in ocular hypotensive medications or further glaucoma surgery). Secondary outcomes were change in IOP, number of ocular hypotensive medications and safety.
The mean follow-up was 32.6 ±10.3 months. Preoperative clinical characteristics were similar in both groups. At latest follow-up, success rate was greater with phaco-TCP than phaco-ECP (67.6% and 47.8%, P=0.037). IOP was also significantly lower after phaco-TCP (14.88±5.57 mm Hg, from 22.62±6.52 mm Hg) than phaco-ECP (18.07±6.72 mm Hg, from 22.83±7.88, P=0.0273). Ocular hypotensive medications required reduced similarly after phaco-TCP (from 3.38±0.88 to 2.65±1.04 medications, P=0.0012) and phaco-ECP (from 3.07±0.929 to 2.63±1.42 medications, P=0.0108). There were no cases of hypotony or reduction in vision related to glaucoma with either surgical intervention and a similar proportion required further glaucoma surgery (phaco-ECP 15.2%, phako-TCP 5.9%, P=0.2884).
Phaco-TCP appears more successful in controlling IOP than phaco-ECP with similar safety. Further investigation is warranted of this newly proposed combination which may be particularly useful where access or experience with ECP or other minimally invasive glaucoma surgery is limited.
本研究旨在报告超声乳化联合经巩膜睫状体光凝术（phaco-TCP）与超声乳化联合内路睫状体光凝术（phaco-ECP）治疗青光眼伴白内障的中期疗效，前者为新型联合术式，后者为传统联合术式。
本研究为回顾性病例系列研究，共纳入 80 例患者（80 只眼），随访时间均至少 12 个月。其中，46 只眼接受 phaco-ECP，34 只眼接受 phaco-TCP。成功定义为眼压（IOP）在 6 至 21mmHg 之间，且较术前降低≥20%（无需增加降眼压药物或进一步行青光眼手术）。次要观察终点为 IOP 变化、降眼压药物使用数量和安全性。
平均随访时间为 32.6±10.3 个月。两组患者术前临床特征相似。末次随访时，phaco-TCP 组的成功率（67.6%）显著高于 phaco-ECP 组（47.8%）（P=0.037）。phaco-TCP 组术后 IOP 显著低于 phaco-ECP 组（14.88±5.57mmHg 比 18.07±6.72mmHg，P=0.0273）。phaco-TCP 组和 phaco-ECP 组术后降眼压药物使用数量均减少（分别由 3.38±0.88 降至 2.65±1.04 种和由 3.07±0.929 降至 2.63±1.42 种，均 P=0.0012 和 P=0.0108）。两组均无眼压过低或与青光眼相关的视力下降病例，且需要进一步行青光眼手术的比例相似（phaco-ECP 组 15.2%，phaco-TCP 组 5.9%，P=0.2884）。
与 phaco-ECP 相比，phaco-TCP 治疗青光眼合并白内障更能有效控制眼压，且安全性相当。该新型联合术式可能尤其适用于 ECP 或其他微创青光眼手术经验或条件有限的情况，值得进一步研究。
