Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China.
Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, USA.
Clin Exp Ophthalmol. 2020 Dec;48(9):1201-1209. doi: 10.1111/ceo.13868. Epub 2020 Oct 27.
This is the first comprehensive comparison between ab interno approach and ab externo approach for microcatheter-assisted trabeculotomy in primary congenital glaucoma with clear cornea.
Ab externo microcatheter-assisted trabeculotomy is considered to be the gold standard for primary congenital glaucoma. The novel ab interno approach would intuitively be similar to ab externo approach for microcatheter-assisted trabeculotomy in eyes with clear cornea; however, there is no evidence yet.
Non-contemporary comparison of retrospective case series.
Fifty-eight and fifty-seven consecutive primary congenital glaucoma eyes with clear corneas underwent ab interno and ab externo microcatheter-assisted trabeculotomy, respectively.
Retrospective comparison of clinical outcomes.
Surgical success was defined as a postoperative intraocular pressure of ≤21 mmHg with at least a 30% reduction from preoperative IOP with or without the use of anti-glaucoma medication (qualified and complete success, respectively).
The qualified success rate (87.9% vs 82.2%, P = .40) and complete success rates (81.0% vs 73.3%, P = .32) were comparable between groups. Complications were minimal and comparable. Less than 360° trabeculotomy (P = .009) and a higher number of previous surgeries (P = .03) were both associated with worse surgical outcomes.
Ab interno approach provide good and comparable outcomes as ab externo approach for microcatheter-assisted trabeculotomy in primary congenital glaucoma eyes with clear cornea. It should be considered as the initial choice in these patients with the benefit of sparing conjunctiva. Successful trabeculotomy with either technique during the first attempt is critical to overall success and underscores the need for proficiency before independent practice.
这是首次对无巩膜隧道的经内路和有巩膜隧道的经外路微导管辅助小梁切开术治疗先天性青光眼的全面比较。
无巩膜隧道的微导管辅助小梁切开术被认为是先天性青光眼的金标准。新型的经内路微导管辅助小梁切开术在透明角膜眼的直观上类似于经外路微导管辅助小梁切开术；然而，目前尚无相关证据。
非同期回顾性病例系列比较。
分别有 58 只和 57 只连续的先天性青光眼透明角膜眼接受了经内路和经外路微导管辅助小梁切开术。
回顾性临床结果比较。
手术成功定义为术后眼压≤21mmHg，与术前眼压相比至少降低 30%，且无需或仅需使用抗青光眼药物（合格成功和完全成功）。
两组的合格成功率（87.9%比 82.2%，P=0.40）和完全成功率（81.0%比 73.3%，P=0.32）相当。并发症轻微且相似。少于 360°的小梁切开（P=0.009）和更多的先前手术（P=0.03）都与手术结果较差相关。
无巩膜隧道的经内路微导管辅助小梁切开术在先天性青光眼透明角膜眼中的效果与有巩膜隧道的经外路微导管辅助小梁切开术相当，可作为这些患者的初始选择，具有节省结膜的优势。在首次尝试中，无论是哪种技术，成功进行小梁切开术对于整体成功都至关重要，这凸显了在独立实践之前需要具备熟练的技术。
