Vez Sarah, Müller Luzia, Bochmann Frank
Augenklinik, Luzerner Kantonsspital, Luzern, Switzerland.
Klin Monbl Augenheilkd. 2021 Apr;238(4):391-395. doi: 10.1055/a-1425-6888. Epub 2021 Apr 30.
To evaluate the outcome of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma (OAG).
A retrospective case series of patients with uncontrolled OAG treated by GATT at the cantonal Hospital Lucerne, a tertiary referral center, between October 2018 and July 2019 with a minimal 6-month follow-up period. Main outcome measures were intraocular pressure (IOP), number of antiglaucoma medications, and complications.
Thirty-one eyes of 29 patients with a mean age of 70.9 years and a minimal follow-up period of 6 months were included in this study. Twenty eyes were treated for pseudoexfoliation (64.5%), seven for primary open-angle (22.6%), three for pigmentary (9.7%), and one for traumatic (3.2%) glaucoma. Twenty-six eyes had data at the 6-month follow-up and 12 eyes at the 12-month follow-up. Twenty-two eyes (70.9%) were pseudophakic prior to the operation. Mean preoperative IOP was 33 mmHg (standard deviation [SD] 8.0 mmHg). The postoperative IOP was 13.9 mmHg [SD 2.2] at the 6- and 13.9 mmHg [SD 3.1] at the 12-month follow-up. The postoperative IOP evolution translated into a 58% decrease between 6 and 12 months (p < 0.001). Thirteen patients (41.9%) were treated with oral Diamox prior to GATT. The number of antiglaucoma medications decreased from a preoperative average of 2.9 [SD 1.2] to postoperative 1 [SD 1] drug (p < 0.001). The most frequent adverse event was the occurrence of postoperative hyphema. Hyphema was observed in 21 (68.0%), 7 (22.6%), and 2 (6.4%) eyes at days 1, 7, and 30 after GATT, respectively. Intraocular hypertension over 25 mmHg was seen in eight eyes (25.8%), and in four of them, a steroid response was suspected. One patient developed an anterior uveitis and a macular edema.
GATT is an effective and safe intervention for OAG, particularly in pseudoexfoliation glaucoma (PEX). The advantages of GATT compared to filtration surgery are the low rate of long-term complications and that the intervention is feasible even when difficult conjunctival conditions are encountered.
评估前房角镜辅助小梁切开术（GATT）治疗开角型青光眼（OAG）患者的疗效。
这是一项回顾性病例系列研究，纳入了2018年10月至2019年7月在三级转诊中心卢塞恩州立医院接受GATT治疗且随访期至少为6个月的未控制型OAG患者。主要观察指标为眼压（IOP）、抗青光眼药物使用数量及并发症。
本研究纳入了29例患者的31只眼，平均年龄70.9岁，最短随访期为6个月。其中20只眼因假性剥脱性青光眼接受治疗（64.5%），7只眼因原发性开角型青光眼（22.6%），3只眼因色素性青光眼（9.7%），1只眼因外伤性青光眼（3.2%）。26只眼有6个月随访数据，12只眼有12个月随访数据。22只眼（70.9%）在手术前为人工晶状体眼。术前平均眼压为33 mmHg（标准差[SD] 8.0 mmHg）。术后6个月眼压为13.9 mmHg [SD 2.2]，术后12个月眼压为13.9 mmHg [SD 3.1]。术后眼压变化显示在6至12个月间下降了58%（p < 0.001）。13例患者（41.9%）在GATT治疗前使用了口服醋甲唑胺。抗青光眼药物使用数量从术前平均2.9种[SD 1.2]降至术后1种[SD 1]（p < 0.001）。最常见的不良事件是术后前房积血。GATT术后第1天、第7天和第30天分别有21只眼（68.0%）、7只眼（22.6%）和2只眼（6.4%）出现前房积血。8只眼（25.8%）出现眼压高于25 mmHg，其中4只眼怀疑有类固醇反应。1例患者发生了前葡萄膜炎和黄斑水肿。
GATT是治疗OAG的一种有效且安全的干预措施，尤其在假性剥脱性青光眼（PEX）中。与滤过性手术相比，GATT的优势在于长期并发症发生率低，且即使遇到结膜条件困难时该干预措施仍可行。
