Mano Sofia Sousa, Esteves Raquel Marques, Ferreira Nuno Pinto, Abegão Pinto Luís
Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Norte, EPE - Hospital de Santa Maria, Lisbon, Portugal.
Department of Ophthalmology, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
Eur J Ophthalmol. 2021 Mar;31(2):477-481. doi: 10.1177/1120672120901699. Epub 2020 Jan 27.
To analyse the efficacy and safety of a standardized laser suture lysis protocol following trabeculectomy.
Prospective interventional study conducted at a tertiary centre, between June 2016 and July 2017. Consecutive patients undergoing primary trabeculectomy with mitomycin C (0.4 mg/mL) for open angle glaucoma were enrolled. According to study protocol, a first laser suture lysis was performed routinely when intraocular pressure was greater than 10 mmHg, starting at postoperative day 8, and a second laser suture lysis was done whenever the intraocular pressure was newly greater than 10 mmHg, with a minimum interval of 1 week after the first laser suture lysis. Primary outcome was intraocular pressure (mean value, and mean difference from baseline in percentage). Safety parameters were also analysed.
Thirty-three eyes of 28 patients (13 males) were enrolled with a mean age of 69.6 ± 15.1 years. Pre-operative intraocular pressure was 24.9 ± 8.6 mmHg. All eyes underwent a laser suture lysis before the 12th postoperative week, with a mean intraocular pressure-lowering efficacy of 42.4% (p < 0.01). A second laser suture lysis procedure, when performed (n = 14), had an additional intraocular pressure-lowering efficacy of 26.7% (p = 0.02). Mean intraocular pressure at 1-month follow-up was 12.9 ± 8.2 mmHg, and during this period, two cases of self-limited choroidal detachments were noticed. Ten patients needed additional bleb needling. Mean intraocular pressure at 1-year follow-up was 13.8 ± 8.0 mmHg under an average of 0.4 topical intraocular pressure-lowering drugs (p < 0.01).
In our study, laser suture lysis was an effective tool to lower intraocular pressure during the early postoperative period, with an acceptable safety profile.
分析小梁切除术后标准化激光缝线松解术的疗效和安全性。
2016年6月至2017年7月在一家三级中心进行的前瞻性干预研究。纳入因开角型青光眼接受丝裂霉素C（0.4mg/mL）原发性小梁切除术的连续患者。根据研究方案，当眼压高于10mmHg时常规进行首次激光缝线松解术，从术后第8天开始，每当眼压新高于10mmHg时进行第二次激光缝线松解术，第一次激光缝线松解术后间隔至少1周。主要结局指标为眼压（平均值，以及与基线相比的平均差值百分比）。还分析了安全性参数。
纳入28例患者（13例男性）的33只眼，平均年龄69.6±15.1岁。术前眼压为24.9±8.6mmHg。所有眼均在术后第12周前接受了激光缝线松解术，平均眼压降低效果为42.4%（p<0.01）。第二次激光缝线松解术（n=14）实施时，额外的眼压降低效果为26.7%（p=0.02）。1个月随访时的平均眼压为12.9±8.2mmHg，在此期间，发现2例自限性脉络膜脱离。10例患者需要额外的滤泡针刺术。1年随访时的平均眼压为13.8±8.0mmHg，平均使用0.4种局部降眼压药物（p<0.01）。
在我们的研究中，激光缝线松解术是术后早期降低眼压的有效工具，安全性可接受。
