Pahlitzsch Milena, Davids Anja-Maria, Winterhalter Sibylle, Zorn Malte, Reitemeyer Emanuel, Klamann Matthias K J, Torun Necip, Bertelmann Eckart, Maier Anna-Karina
Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
Ophthalmol Ther. 2021 Sep;10(3):509-524. doi: 10.1007/s40123-021-00347-0. Epub 2021 May 7.
To evaluate the long-term effect on intraocular pressure (IOP) and glaucoma medication of selective laser trabeculoplasty (SLT) compared to minimally invasive glaucoma surgery (MIGS) in primary open-angle glaucoma (POAG) and its potential in clinical practice.
A total of 342 consecutive patients (stand-alone procedures) were included. One hundred and five patients underwent SLT treatment (360° SLT, 95-105 spots, Trabeculas SLT ARCLaser, Nürnberg, DE), 107 patients had an ab interno-derived trabeculotomy (Trabectome, NeoMedix, Tustin, USA), and 130 patients received iStent inject implantation (2 implants-Glaukos, CA, USA). IOP and glaucoma therapy were evaluated preoperatively, 1 day, 6 weeks, 3 months, 6 months, and 1, 2, and 3 years postoperatively. Statistical analysis was performed using a regression model and propensity matching score (reduced cohort number) using SPSS v20.0. Kaplan-Meier analysis was included using the following six criteria: criterion A (IOP ≤ 21 mmHg with or without medication, qualified success), criterion B (IOP ≤ 18 mmHg with or without medication, qualified success), criterion C (IOP ≤ 21 mmHg without medication, complete success), criterion D (IOP ≤ 18 mmHg without medication, complete success), criterion E (IOP ≤ 21 mmHg and IOP reduction > 20% after therapy), and criterion F (IOP ≤ 18 mmHg and IOP reduction > 20% after therapy).
In the matched cohort, the SLT cohort showed an IOP reduction of 31.2% from 19.9 ± 2.3 to 13.7 ± 2.7 mmHg (p < 0.001) 3 years postoperatively; in Trabectome IOP decreased by 31.4% from 20.5 ± 1.3 to 13.8 ± 2.0 mmHg (p < 0.001) and in iStent inject by 29.9% from 19.5 ± 2.0 to 13.8 ± 2.7 mmHg (p < 0.001). Trabectome and iStent inject could not demonstrate a significant reduction in glaucoma therapy (Trabectome p = 0.138, iStent inject p = 0.612); a significant drop was noted in SLT (2.2 ± 1.2 to 1.7 ± 1.2, p = 0.046). SLT and MIGS achieved good to moderate survival rates using criterion A (93.3% SLT, 79.7% Trabectome, 77.6% iStent inject) and criterion B (74.5% SLT, 48.0% Trabectome, 56.2% iStent inject). As expected, low survival rates were obtained with non-filtering procedures: criterion C 11.1% in SLT, 6.5% in Trabectome, 7.0% in iStent inject and criterion D 3.0% in SLT, 4.3% in Trabectome, 3.7% in iStent inject in 3-year follow-up.
The SLT is a low-complication and effective method for reducing pressure in mild to moderate POAG. SLT is suitable as an initial procedure when setting up a step scheme; MIGS is the treatment of choice as a follow-up for mild to moderate forms of glaucoma and accepted topical therapy. Ethic approval had been given by the Ethikkommission Charité - Universitätsmedizin Berlin, EA4/047/20-retrospectively registered.
评估选择性激光小梁成形术（SLT）与微创青光眼手术（MIGS）相比，对原发性开角型青光眼（POAG）眼压（IOP）和青光眼药物治疗的长期影响及其在临床实践中的潜力。
共纳入342例连续患者（独立手术）。105例患者接受SLT治疗（360°SLT，95 - 105个光斑，Trabeculas SLT ARCLaser，德国纽伦堡），107例患者进行内路小梁切开术（Trabectome，美国NeoMedix公司，加利福尼亚州图斯廷），130例患者接受iStent inject植入术（2枚植入物 - Glaukos公司）。在术前、术后1天、6周、3个月、6个月以及1、2和3年评估眼压和青光眼治疗情况。使用回归模型和倾向匹配评分（减少队列数量），采用SPSS v20.0进行统计分析。采用以下六个标准进行Kaplan - Meier分析：标准A（使用或不使用药物眼压≤21 mmHg，合格成功）、标准B（使用或不使用药物眼压≤18 mmHg，合格成功）、标准C（不使用药物眼压≤21 mmHg，完全成功）、标准D（不使用药物眼压≤18 mmHg，完全成功）、标准E（眼压≤21 mmHg且治疗后眼压降低>20%）和标准F（眼压≤18 mmHg且治疗后眼压降低>20%）。
在匹配队列中，SLT组术后3年眼压从19.9±2.3 mmHg降低至13.7±2.7 mmHg，降低了31.2%（p<0.001）；Trabectome组眼压从20.5±1.3 mmHg降低至13.8±2.0 mmHg，降低了31.4%（p<0.001）；iStent inject组眼压从19.5±2.0 mmHg降低至13.8±2.7 mmHg，降低了29.9%（p<0.001）。Trabectome组和iStent inject组在青光眼药物治疗方面未显示出显著降低（Trabectome组p = 0.138，iStent inject组p = 0.
