Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong.
Hong Kong Eye Hospital.
J Glaucoma. 2020 May;29(5):386-392. doi: 10.1097/IJG.0000000000001465.
This 1-year prospective study demonstrated that the Tenon's layer reposition approach of trabeculectomy could achieve zero leakage rate, minimal rate of transient hypotony without compromising the surgical outcome.
The purpose of this study was to investigate the effectiveness and safety of a Tenon's layer reposition approach of trabeculectomy.
A prospective, noncomparative case series of 30 eyes of 30 Chinese patients with mixed types of glaucoma who underwent fornix-based trabeculectomy combined with intraoperative mitomycin C application. During the conjunctival flap closure, the Tenons' layer was identified, separated, and anchored on to the sclera surface with 8/0 vicryl, followed by conjunctival closure with 10/0 nylon as a separate layer. All patients were followed up for 1 year. Assessment including intraocular pressure (IOP), vertical cup-disc ratio measurement, best-corrected visual acuity, and visual field examination were performed before and after the operation. Qualified and complete success was defined as IOP of ≤21 mm Hg in 2 consecutive visits with or without medication, respectively. Outcomes were evaluated using scattered plot and Kaplan-Meier survival curve.
Twenty-one eyes (70%) and 28 eyes (93.3%) achieved complete and partial success at 1 year, respectively. There was a significant reduction of IOP (28.5±9.6 to 15.5±2.6 mm Hg, P<0.001) and medication use (4.4±0.9 to 0.8±1.2 bottles/eye, P<0.001). There were no significant changes in best-corrected visual acuity, vertical cup-disc ratio, and visual field indices. No wound leak was identified throughout the study. The procedure did not induce significant astigmatic change. Other postoperative complications, including 2 eyes (6.7%) with transient hypotony and 1 eye (3.3%) required cataract surgery, were of relatively low rate.
The Tenon's layer reposition approach of performing trabeculectomy is a safe and efficacious procedure for Chinese subjects with different types of glaucoma.
这项为期 1 年的前瞻性研究表明，经Tenon 囊层复位施行小梁切除术，可实现零渗漏率和一过性低眼压发生率极低，且不影响手术效果。
本研究旨在评估经Tenon 囊层复位施行小梁切除术的有效性和安全性。
本研究为前瞻性、非对照病例系列研究，共纳入 30 例（30 眼）中国混合性青光眼患者，施行穹窿部为基底的小梁切除术，并在术中应用丝裂霉素 C。在结膜瓣关闭时，识别、分离Tenon 囊层，并使用 8/0 薇乔缝线将其锚定于巩膜表面，随后使用 10/0 尼龙缝线作为单独的一层进行结膜闭合。所有患者均随访 1 年。术前和术后分别进行眼压（IOP）、垂直杯盘比测量、最佳矫正视力和视野检查。将 IOP 在连续 2 次就诊时≤21mmHg 且无需药物治疗（完全成功）或≤21mmHg 且需药物治疗（部分成功）定义为合格且完全成功。使用散点图和 Kaplan-Meier 生存曲线评估结果。
1 年后，21 只眼（70%）和 28 只眼（93.3%）分别达到完全和部分成功。IOP 显著降低（28.5±9.6mmHg 至 15.5±2.6mmHg，P<0.001），药物使用量也显著减少（4.4±0.9 瓶/眼至 0.8±1.2 瓶/眼，P<0.001）。最佳矫正视力、垂直杯盘比和视野指数均无显著变化。整个研究过程中均未发现伤口渗漏。该手术不会引起明显的散光变化。其他术后并发症的发生率相对较低，包括 2 只眼（6.7%）出现一过性低眼压和 1 只眼（3.3%）需要行白内障手术。
对于不同类型青光眼的中国患者，经Tenon 囊层复位施行小梁切除术是一种安全有效的手术方法。
