Wons Juliana, Mihic Nadine, B Pfister Isabel, Anastasi Stefano, Garweg Justus G, Halberstadt Markus
Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland.
Department of Ophthalmology, University of Bern, Bern, Switzerland.
Clin Ophthalmol. 2021 May 6;15:1851-1860. doi: 10.2147/OPTH.S303603. eCollection 2021.
This study aimed to compare the effect of trabectome surgery in patients with and without intolerance to their medication and with preoperatively sufficiently controlled, insufficiently controlled, and uncontrolled intraocular pressure (IOP) on the surgical outcome.
A total of 155 eyes (133 patients) with different forms of open angle glaucoma with or without intolerance to their glaucoma medication undergoing trabectome surgery alone (AIT) or combined with phacoemulsification (phaco-AIT) were included in this retrospective monocentric study. Patients were corresponding to IOP ≤ 18 mmHg (controlled but glaucoma progression or intolerance, group 1), 19-26 mmHg (insufficiently controlled, group 2), and ≥ 26 mmHg (not controlled, group 3), respectively. Pre- and postoperative IOP and the number of IOP-lowering medications were registered over 12 months. Surgical success was defined as a postoperative IOP of ≤18mmHg and/or reduction of the topical treatment demand after 1 year.
Of the 155 included eyes, 79 received AIT and 76 received phaco-AIT. Sixty-nine eyes had a preoperatively sufficiently controlled IOP, 63 had an insufficiently controlled IOP, and 23 had an uncontrolled IOP. In all groups, the IOP significantly dropped by 6 and 12 months after surgery ( < 0.001). Surgical success war similar in all groups [47.8% (group 1), 38.1 (group 2) and 34.8% (group 3); p= 0.47]. The effect of AIT on IOP and glaucoma medication independent of intolerance to the anti-glaucoma medication and type of surgery (AIT/phaco-AIT).
Independently of the preoperative IOP, a satisfying surgical success was achieved using AIT. In instances that do not qualify for filtrating surgery, trabectome surgery alone or in combination with phacoemulsification thus represents a safe and effective minimally invasive glaucoma surgery technique regardless of an intolerance to the topical medication.
本研究旨在比较小梁切除术对药物不耐受和药物不耐受的患者、术前眼压得到充分控制、未充分控制和未控制的患者手术效果的影响。
本回顾性单中心研究纳入了155只眼（133例患者），这些患者患有不同类型的开角型青光眼，有或没有青光眼药物不耐受，单独接受小梁切除术（AIT）或联合超声乳化术（phaco-AIT）。患者分别对应眼压≤18 mmHg（眼压得到控制但有青光眼进展或药物不耐受，第1组）、19 - 26 mmHg（未充分控制，第2组）和≥26 mmHg（未控制，第3组）。在12个月内记录术前和术后的眼压以及降眼压药物的使用数量。手术成功定义为术后眼压≤18 mmHg和/或1年后局部治疗需求减少。
在纳入的155只眼中，79只接受了AIT，76只接受了phaco-AIT。69只眼术前眼压得到充分控制，63只眼未充分控制，23只眼未控制。在所有组中，术后6个月和12个月眼压显著下降（<0.001）。所有组的手术成功率相似[47.8%（第1组），38.1%（第2组）和34.8%（第3组）；p = 0.47]。AIT对眼压和青光眼药物的影响与抗青光眼药物不耐受和手术类型（AIT/phaco-AIT）无关。
无论术前眼压如何，使用AIT均取得了令人满意的手术成功率。在不符合滤过性手术条件的情况下，单独的小梁切除术或联合超声乳化术因此代表了一种安全有效的微创青光眼手术技术，无论对局部药物是否不耐受。
