Department of Ophthalmology, Istanbul Training and Research Hospital, Istanbul, Turkey.
Department of Ophthalmology, Training and Research Hospital, Abant Izzet Baysal University, Kılıçarslan Mah. 144. Sk No: 7, 6 Merkez, Bolu, Turkey.
Int Ophthalmol. 2020 Aug;40(8):1923-1930. doi: 10.1007/s10792-020-01364-x. Epub 2020 Apr 11.
To evaluate the safety and efficacy profile of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma with a history of previous failed trabeculectomy surgery.
This case-series study included 26 eyes of 26 consecutive patients with a mean age of 64.1 ± 4.5 (56-78) years who underwent GATT using the 5/0 prolene suture to treat medically uncontrolled moderate to advanced glaucoma despite the previous trabeculectomy surgery. At baseline and each visit, Snellen best-corrected visual acuity (BCVA), IOP values, cup-to-disc (C/D) ratio, retinal nerve-fiber layer thickness and mean deviation values in visual field test were recorded. Need for medication or further glaucoma surgery were noted. Surgical success was defined as final IOP ≤ 15 mmHg and ≥ 20% IOP reduction from baseline without any further glaucoma surgery.
Twelve (46.2%) patients with primary open angle glaucoma (POAG) and fourteen (53.8%) patients with pseudoexfoliative glaucoma (PEXG) underwent GATT. Average baseline IOP was 25.3 ± 5.4 (16-45) mmHg. Mean follow-up time was 17.8 ± 4.1 (12-26) months. Mean baseline BCVA was 0.47 ± 0.25. Surgical success was achieved in 16 of 26 (61.5%). In ten of patients, medically uncontrolled glaucoma persisted after GATT surgery and they underwent further glaucoma surgery. PEXG patients showed a higher IOP reduction than POAG patients did at last follow-up (45.6% vs 34.8%).
The present study revealed that GATT was an effective procedure as a second IOP-lowering surgery in PEXG patients having previous failed trabeculectomy. However, in POAG patients having previous failed trabeculectomy, GATT seems to have a limited efficacy.
评估既往失败的小梁切除术患者的开角型青光眼患者行房角镜辅助经巩膜隧道小梁切开术（GATT）的安全性和疗效。
本病例系列研究纳入 26 例（26 只眼）患者，平均年龄 64.1±4.5（56-78）岁，均因药物治疗无法控制中重度至晚期青光眼，且既往行小梁切除术失败后，采用 5/0 聚丙烯缝线行 GATT 治疗。在基线和每次就诊时，记录患者的最佳矫正视力（BCVA）、眼压（IOP）值、杯盘比（C/D）、视网膜神经纤维层厚度和视野测试的平均偏差值。记录药物需求或进一步的青光眼手术情况。手术成功定义为最终 IOP≤15mmHg，且与基线相比 IOP 降低≥20%，无需进一步行青光眼手术。
12 例（46.2%）原发性开角型青光眼（POAG）和 14 例（53.8%）假性剥脱性青光眼（PEXG）患者接受了 GATT 治疗。平均基线 IOP 为 25.3±5.4（16-45）mmHg。平均随访时间为 17.8±4.1（12-26）个月。平均基线 BCVA 为 0.47±0.25。26 例患者中 16 例（61.5%）手术成功。10 例患者行 GATT 术后仍存在药物无法控制的青光眼，后行进一步的青光眼手术。末次随访时，PEXG 患者的 IOP 降低率高于 POAG 患者（45.6%vs34.8%）。
本研究表明，对于既往失败的小梁切除术患者，GATT 是一种有效的二次降眼压手术，在 PEXG 患者中效果较好。然而，在既往失败的小梁切除术患者中，GATT 的效果似乎有限。
