联合白内障手术和房角镜辅助经巩膜小梁切开术（GATT）与白内障手术和 iStent Inject 治疗的 1 年手术效果比较。

Comparison of 1-year surgical outcomes of combined cataract surgery and gonioscopy-assisted transluminal trabeculotomy (GATT) versus cataract surgery and iStent Inject.

机构信息

Birmingham and Midland Eye Centre, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH, UK.

New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton Rd, Heath Town, Wolverhampton, WV10 0QP, UK.

出版信息

Graefes Arch Clin Exp Ophthalmol. 2021 Oct;259(10):3035-3044. doi: 10.1007/s00417-021-05133-z. Epub 2021 May 20.

DOI:10.1007/s00417-021-05133-z

PMID:34014384

Abstract

PURPOSE

Evaluate the efficacy, safety, and complication rates of phacoemulsification cataract surgery when combined with either gonioscopy-assisted transluminal trabeculotomy (GATT) or iStent Inject.

METHODS

This is a retrospective case-control study to compare the surgical outcomes of combined phacoemulsification cataract surgery with either GATT (phaco-GATT) or iStent Inject (phaco-iStent). Both groups had at least 1-year follow-up. The primary outcome measures were IOP and number of glaucoma medications (NGMs) at 1 year. Secondary outcomes measures were best corrected visual acuity (BCVA) and intra- or postoperative complications within the first year of follow-up. Success was defined as intraocular pressure (IOP) < 21 mmHg and ≥ 20% reduction in IOP at 1 year regardless of the NGM.

RESULTS

Each group included 37 patients. The median baseline IOP (24 vs 17) and NGM (3 vs 2) were higher in the phaco-GATT group (p < 0.001). Phaco-GATT achieved a 38% (p < 0.0001) reduction in IOP compared to 13.2% (p < 0.001) in the phaco-iStent group at 1-year follow-up. The reduction in IOP and NGM was significantly higher in the phaco-GATT group (p < 0.01). After adjusting for baseline IOP, the reduction in IOP at 12 months was still significantly higher in the phaco-GATT group (p = 0.042). At 1 year, 86.4% of patients in the phaco-GATT group met the success criteria compared to 35.1% in the phaco-iStent group. Safety outcomes were slightly favourable in the phaco-iStent group.

CONCLUSION

Phaco-GATT and phaco-iStent showed a significant reduction in IOP and NGM, with phaco-GATT having a significantly higher reduction. Phaco-iStent appears to have a higher safety profile and is probably preferable in monocular patients and those with a high risk of bleeding.

摘要

目的

评估超声乳化白内障吸除术联合房角镜辅助经巩膜隧道小梁切开术（GATT）或 iStent Inject 的疗效、安全性和并发症发生率。

方法

这是一项回顾性病例对照研究，比较了超声乳化白内障吸除术联合 GATT（超声乳化-GATT）或 iStent Inject（超声乳化-iStent）的手术效果。两组均有至少 1 年的随访。主要观察指标为术后 1 年时眼压（IOP）和降眼压药物（NGM）的数量。次要观察指标为最佳矫正视力（BCVA）和术后 1 年内的术中或术后并发症。成功定义为眼压（IOP）<21mmHg，且术后 1 年时眼压降低≥20%，无论 NGM 如何。

结果

每组各有 37 例患者。超声乳化-GATT 组的基线眼压（24mmHg 比 17mmHg）和 NGM（3 比 2）中位数更高（p<0.001）。术后 1 年，超声乳化-GATT 组眼压降低 38%（p<0.0001），而超声乳化-iStent 组眼压降低 13.2%（p<0.001）。超声乳化-GATT 组眼压和 NGM 的降低幅度明显大于超声乳化-iStent 组（p<0.01）。调整基线眼压后，超声乳化-GATT 组术后 12 个月时眼压降低仍显著高于超声乳化-iStent 组（p=0.042）。术后 1 年，超声乳化-GATT 组 86.4%的患者符合成功标准，而超声乳化-iStent 组仅为 35.1%。超声乳化-iStent 组的安全性结果略好。