Department of Ophthalmology, Gazi University School of Medicine, Ankara.
Department of Ophthalmology, Training and Research Hospital, Abant Izzet Baysal University, Bolu, Turkey.
J Glaucoma. 2021 Mar 1;30(3):e114-e118. doi: 10.1097/IJG.0000000000001738.
The present study demonstrates that surgical success rates of gonioscopy-assisted transluminal trabeculotomy (GATT) with a target intraocular pressure (IOP)≤21 mm Hg are 93.3% (for qualified success) and 26.7% (for complete success) in vitrectomized patients exhibiting secondary open-angle glaucoma (SOAG) after silicone oil (SO) removal, for an average follow-up of 37.5 months.
To report the long-term outcomes of GATT in vitrectomized patients exhibiting SOAG after SO removal.
Retrospective case-series study.
This retrospective case-series study enrolled vitrectomized patients who underwent uneventful GATT surgery between May 2014 and May 2019 at Gazi University Hospital for the treatment of medically uncontrolled SOAG after SO removal.
At baseline and at each postoperative visit, a detailed ophthalmic examination consisting of slit-lamp biomicroscopy, indirect ophthalmoscopy, macular optical coherence tomography, and Goldmann applanation tonometry was performed in all patients. Baseline demographic and clinical characteristics, duration between pars plana vitrectomy and SO removal, duration between SO removal and onset of SOAG, follow-up time, need for antiglaucoma medication, visual acuity, and IOP measurements were noted. Surgical success was defined as an IOP≤21 and ≥6 mm Hg with (qualified success) and without (complete success) IOP-lowering medication.
A total of 15 patients had a history of pars plana vitrectomy with 1000 centistoke SO tamponade before the GATT surgery. GATT was performed in all patients with SOAG after SO removal. The mean age and follow-up of the patients were 53.6±11.8 years (range, 34 to 72 y) and 37.5±15.1 months (range, 12 to 61 mo), respectively. The average duration of SO tamponade in the vitreous cavity was 7.5±1.6 months (range, 5 to 10 mo). The average duration between the SO removal and the development of SOAG was 14.1±13.2 months (range, 2 to 46 mo). The mean IOP decreased from 31.0±4.1 mm Hg at baseline to 15.6±4.6 mm Hg at final visit. The mean final logMAR BCVA was 0.92±0.58 (range, 2 to 0.045). Qualified surgical success was achieved in 14 (93.3%) patients, whereas complete success was achieved in only 4 (26.7%) patients (P<0.001).
GATT seems to be safe and successful procedure for controlling IOP in patients exhibiting SOAG after SO removal. However, most patients may require antiglaucoma medication during the follow-up, particularly within the first 2 postoperative years.
本研究表明，对于接受硅油（SO）取出术后发生继发性开角型青光眼（SOAG）的玻璃体切割患者，行房角镜辅助经巩膜隧道小梁切开术（GATT），以眼压（IOP）≤21mmHg 为目标眼压，手术成功率为 93.3%（合格成功）和 26.7%（完全成功），平均随访时间为 37.5 个月。
报告 GATT 治疗 SO 取出术后发生 SOAG 的玻璃体切割患者的长期结果。
回顾性病例系列研究。
这项回顾性病例系列研究纳入了 2014 年 5 月至 2019 年 5 月在加济大学医院接受无并发症 GATT 手术的玻璃体切割患者，这些患者因 SO 取出术后药物治疗无法控制的 SOAG 而行 GATT 手术。
所有患者在基线和每次术后访视时均进行详细的眼科检查，包括裂隙灯生物显微镜检查、间接检眼镜检查、黄斑光学相干断层扫描和 Goldmann 压平眼压测量。记录基线人口统计学和临床特征、玻璃体切除术和 SO 取出之间的时间、SO 取出和 SOAG 发作之间的时间、随访时间、抗青光眼药物的需要、视力和眼压测量值。手术成功定义为眼压≤21mmHg 且≥6mmHg，无需（合格成功）和需要（完全成功）降压药物。
共有 15 名患者有玻璃体切除术史，其中 1000 厘沲 SO 填充在 GATT 手术前进行。所有发生 SOAG 后接受 SO 取出的患者均行 GATT 手术。患者的平均年龄和随访时间分别为 53.6±11.8 岁（范围 34 至 72 岁）和 37.5±15.1 个月（范围 12 至 61 个月）。玻璃体腔内 SO 填充的平均持续时间为 7.5±1.6 个月（范围 5 至 10 个月）。SO 取出与 SOAG 发作之间的平均时间为 14.1±13.2 个月（范围 2 至 46 个月）。眼压从基线时的 31.0±4.1mmHg 降至末次随访时的 15.6±4.6mmHg。平均最终 logMAR BCVA 为 0.92±0.58（范围 2 至 0.045）。14 名（93.3%）患者获得了合格的手术成功，而仅 4 名（26.7%）患者获得了完全成功（P<0.001）。
GATT 似乎是一种安全且成功的控制 SO 取出术后发生 SOAG 患者眼压的方法。然而，大多数患者在随访期间可能需要抗青光眼药物，尤其是在术后 2 年内。
