Mori Sotaro, Murai Yusuke, Ueda Kaori, Sakamoto Mari, Kurimoto Takuji, Yamada-Nakanishi Yuko, Nakamura Makoto
Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan.
Acta Ophthalmol. 2021 Dec;99(8):898-903. doi: 10.1111/aos.14787. Epub 2021 Feb 11.
We compared the 1-year outcomes and early surgery-related complications between 1-quadrant and 2-quadrant microhook ab interno trabeculotomy (TLO).
Medical chart extraction was performed on 47 consecutive patients with 1-quadrant incision and 37 consecutive patients with 2-quadrant incision of trabecular meshwork. Logistic regression analysis was conducted to calculate the propensity score to create a 1:1 match for a comparative analysis of 1-year postoperative success. Success was defined as postoperative intraocular pressure (IOP) between 5-21 mmHg, >20% IOP reduction from baseline, and no additional glaucoma surgery. Outcome-related covariates were age, glaucoma type, mean deviation of visual field tests, preoperative IOP, the number of preoperative glaucoma eye drops and the presence of combined cataract surgery. Thirty eyes from each group were compared.
The median preoperative IOP was not different between the 1-quadrant and 2-quadrant groups (28.5 mmHg, quartile range 23-33.5 versus 27 mmHg, 23.3-30.0, p = 0.47). There was no difference in median postoperative IOP at 1 year (15 mmHg versus 16 mmHg, p = 0.80). The success rate was 73% in the 1-quadrant group versus 70% in the 2-quadrant group (p = 1.00). The 2-quadrant group had a significantly higher proportion of patients with transiently elevated IOP (47%) than the 1-quadrant (17%; Fisher's exact test, p = 0.02). There was no difference of hyphema formation (Fisher's exact test, p = 0.18).
The 1-year success rate was not significantly different between 1- and 2-quadrant incisions of microhook TLO. However, the 2-quadrant TLO showed significantly higher proportion of post-surgical transient IOP elevation.
我们比较了单象限和双象限微钩内路小梁切开术（TLO）的1年预后及早期手术相关并发症。
对47例连续接受单象限小梁网切开术切口的患者和37例连续接受双象限小梁网切开术切口的患者进行病历提取。进行逻辑回归分析以计算倾向得分，从而进行1:1匹配，以对比分析术后1年的成功率。成功定义为术后眼压（IOP）在5-21 mmHg之间，较基线眼压降低>20%，且无需额外的青光眼手术。与预后相关的协变量包括年龄、青光眼类型、视野测试的平均偏差、术前眼压、术前青光眼滴眼液的使用数量以及是否合并白内障手术。对每组30只眼睛进行比较。
单象限组和双象限组术前眼压中位数无差异（28.5 mmHg，四分位数范围23-33.5与27 mmHg，23.3-30.0，p = 0.47）。术后1年眼压中位数无差异（15 mmHg对16 mmHg，p = 0.80）。单象限组成功率为73%，双象限组为70%（p = 1.00）。双象限组术后眼压短暂升高的患者比例（47%）显著高于单象限组（17%；Fisher精确检验，p = 0.02）。前房积血形成情况无差异（Fisher精确检验，p = 0.18）。
微钩TLO的单象限和双象限切口1年成功率无显著差异。然而，双象限TLO术后眼压短暂升高的比例显著更高。
