Izquierdo Juan Carlos, Agudelo Natalia, Rubio Bárbara, Camargo Jorge, Ruiz-Montenegro Katia, Gajardo Consuelo, Rincon Mirel
Research Department, Oftalmosalud Instituto de Ojos, Lima, Perú.
Glaucoma Department, Oftalmosalud Instituto de Ojos, Lima, Perú.
Clin Ophthalmol. 2021 Jan 6;15:11-17. doi: 10.2147/OPTH.S282440. eCollection 2021.
The present study aimed to compare the outcomes of combined phacoemulsification and 360-degree endocyclophotocoagulation with and without goniotomy using a Kahook Dual Blade in patients with glaucoma.
We enrolled 37 patients, 21 of whom underwent combined phacoemulsification with 360-degree endocyclophotocoagulation and goniotomy using a Kahook Dual Blade (tri-modal therapy (T-MT) group). The remaining 16 patients underwent phacoemulsification with endocyclophotocoagulation (bi-modal therapy (B-MT) group). Visual acuity, intraocular pressure, and number of glaucoma medications were recorded before the study and postoperatively on the first day, at week 1, and at 1, 3, 6, 9, and 12 months. Surgical success was defined as an IOP ≤12 mmHg and ≥6 mmHg or an at least 20% reduction in IOP from baseline with (qualified success) or without medications (complete success).
Forty-nine eyes were included. Baseline mean IOP was 16.96±3.66 mmHg and 15.64±4.88 mmHg in the T-MT and B-MT groups (p=0.122), respectively. At the 12-month follow-up, mean IOP values were 11.44±2.15 mmHg and 12.45±1.90 mmHg (p=0.031) in the T-MT and B-MT groups, respectively. Complete success rates were 37% in the T-MT group and 31% in the B-MT group, while qualified success rates were 74% and 50%, respectively. Glaucoma medications decreased from 2.0±1.4 to 0.8±1.0 (p<0.001) in the T-MT group and from 1.5±1.3 to 1.0±1.5 in the B-MT group (p=0.032). Similar improvements in visual acuity were observed in both groups. Complications were mild and resolved without intervention.
The tri-modal treatment is safe and may be more effective in reducing IOP and glaucoma medication requirements than bi-modal treatment.
本研究旨在比较在青光眼患者中，使用卡胡克双刀进行超声乳化联合360度内环光凝术，加或不加房角切开术的治疗效果。
我们纳入了37例患者，其中21例接受了使用卡胡克双刀进行超声乳化联合360度内环光凝术及房角切开术（三联疗法（T-MT）组）。其余16例患者接受了超声乳化联合内环光凝术（双联疗法（B-MT）组）。在研究前以及术后第1天、第1周、第1、3、6、9和12个月记录视力、眼压和青光眼药物使用数量。手术成功定义为眼压≤12 mmHg且≥6 mmHg，或眼压较基线至少降低20%（使用药物（合格成功）或不使用药物（完全成功））。
共纳入49只眼。T-MT组和B-MT组的基线平均眼压分别为16.96±3.66 mmHg和15.64±4.88 mmHg（p = 0.122）。在12个月随访时，T-MT组和B-MT组的平均眼压值分别为11.44±2.15 mmHg和12.45±1.90 mmHg（p = 0.031）。T-MT组的完全成功率为37%，B-MT组为31%，而合格成功率分别为74%和50%。T-MT组青光眼药物使用数量从2.0±1.4降至0.8±1.0（p<0.001），B-MT组从1.5±1.3降至1.0±1.5（p = 0.032）。两组视力均有类似改善。并发症较轻，无需干预即可缓解。
三联疗法安全，在降低眼压和减少青光眼药物使用需求方面可能比双联疗法更有效。
