Cubuk Mehmet Ozgur, Unsal Erkan
Istanbul Research and Education Hospital, Istanbul, Turkey.
Dünyagöz Hospital, Istanbul, Turkey.
Eur J Ophthalmol. 2021 Mar;31(2):460-468. doi: 10.1177/1120672120908716. Epub 2020 Feb 24.
To present the results and complications of gonioscopy-assisted transluminal trabeculotomy in adults with open-angle glaucoma using our different approaches during and after surgery.
A retrospective comparative study was designed. Patients with regular 12-month follow-up history were included. Two groups were defined: group 1 comprised patients with open-angle glaucoma who underwent gonioscopy-assisted transluminal trabeculotomy surgery alone; group 2 included patients with open-angle glaucoma who underwent combined gonioscopy-assisted transluminal trabeculotomy and cataract extraction. A 30% reduction in preoperative intraocular pressure or postoperative intraocular pressure below 18 mm Hg was considered as surgical success. The success rate, alteration in intraocular pressure, alteration in best-corrected visual acuity, alteration in the need for antiglaucomatous medications, surgical complications, and the need for additional glaucoma surgery were evaluated and compared between the groups. Multivariate logistic regression analysis was used to show the association between the surgical success and possible prognostic factors.
A total of 37 eyes fulfilled the inclusion criteria and were analyzed in this study. An overall mean decrease in intraocular pressure of 11.3 ± 9.3 mm Hg was shown at 12 months (p < 0.001). The medication-free surgical success rate was 37.8% (14/37), and the surgical success rate with medication was 91.8% (33/37) at 12 months. Surgical outcomes were similar between patients who underwent gonioscopy-assisted transluminal trabeculotomy alone and those who had combined gonioscopy-assisted transluminal trabeculotomy and cataract extraction (p > 0.05). The most common postoperative complication was hyphemia (89.1%). There were no complications that threatened best-corrected visual acuity. Multivariate logistic regression analysis revealed one significant association between the presence of blood in Schlemm's canal and surgical success (odds ratio = 1.47; 95% confidence interval = 1.25-1.68; p = 0.047).
This study showed that the gonioscopy-assisted transluminal trabeculotomy procedure is an effective and minimally invasive form of glaucoma surgery. Its effect was related to intraoperative blood in Schlemm's canal.
介绍成人开角型青光眼在手术期间及术后采用不同方法进行房角镜辅助小梁切开术的结果及并发症。
设计一项回顾性对照研究。纳入有规律的12个月随访记录的患者。定义两组：第1组包括仅接受房角镜辅助小梁切开术的开角型青光眼患者；第2组包括接受房角镜辅助小梁切开术联合白内障摘除术的开角型青光眼患者。术前眼压降低30%或术后眼压低于18 mmHg被视为手术成功。评估并比较两组之间的成功率、眼压变化、最佳矫正视力变化、抗青光眼药物使用需求变化、手术并发症以及额外青光眼手术需求。采用多因素逻辑回归分析来显示手术成功与可能的预后因素之间的关联。
本研究共分析了37只符合纳入标准的眼睛。12个月时眼压总体平均下降11.3±9.3 mmHg（p<0.001）。12个月时无药物治疗的手术成功率为37.8%（14/37），使用药物的手术成功率为91.8%（33/37）。单纯接受房角镜辅助小梁切开术的患者与接受房角镜辅助小梁切开术联合白内障摘除术的患者手术结果相似（p>0.05）。最常见的术后并发症是前房积血（89.1%）。没有并发症威胁到最佳矫正视力。多因素逻辑回归分析显示施莱姆管内有血与手术成功之间存在显著关联（优势比=1.47；95%置信区间=1.25-1.68；p=0.047）。
本研究表明，房角镜辅助小梁切开术是一种有效且微创的青光眼手术方式。其效果与术中施莱姆管内有血有关。
