Department of Ophthalmology, School of Medicine, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil.
Department of Ophthalmology and Vision Science, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brazil.
Arq Bras Oftalmol. 2021 Nov-Dec;84(6):587-593. doi: 10.5935/0004-2749.20210083.
To report the initial 2 years' learning curve on gonioscopy-assisted transluminal trabeculotomy performed using the thermally blunted suture technique and review the factors that could potentially affect the outcome.
This retrospective study evaluated 100 eyes from 89 participants with glaucoma resistant to maximum clinical treatment, which was defined as having an intraocular pressure >21 mmHg in addition to three or four different hypotensive drugs. Intraocular pressure values at baseline, 1 week, and at 1, 2, 3, 6, 12, and 24 months of follow-up and details regarding the need of antiglaucoma medication and further glaucoma surgery were recorded. Eyes that required further surgical intervention for intraocular pressure control were considered as failure.
A total of 51 eyes were subjected to isolated gonioscopy-assisted transluminal trabeculotomy, and 49 eyes were subjected to gonioscopy-assisted transluminal trabeculotomy + cataract extraction at the same surgical time. A statistically significant difference was observed between overall mean follow-up intraocular pressure and mean preoperative intraocular pressure (p<0.001) in all follow-up visits. When the extent of treatment was evaluated, patients with an extension of 360° did not exhibit statistically significantly lower mean intraocular pressure than those with other extensions. Hyphema was the only complication presented in 50 eyes (50%), but all had spontaneous resolution within 4 weeks. A total of 26 eyes (26%) required additional conventional trabeculectomy due to uncontrolled intraocular pressure, especially those who previously underwent vitreoretinal surgery.
Gonioscopy-assisted transluminal trabeculotomy, besides being an apparently safe procedure, results in satisfactory success rates even during the surgeon's initial learning curve. The technique was effective in decreasing intraocular pressure and medication burden.
报告使用热钝缝线技术行房角镜辅助经巩膜小梁切开术的最初 2 年学习曲线，并回顾可能影响手术结果的因素。
本回顾性研究评估了 89 名患有对最大临床治疗有抵抗的青光眼的 100 只眼，这些青光眼定义为眼压>21mmHg，且使用了三种或四种不同的降压药物。记录了基线、术后 1 周、1、2、3、6、12 和 24 个月的眼压值以及抗青光眼药物的需求和进一步的青光眼手术的详细信息。眼压控制需要进一步手术干预的眼被视为失败。
共有 51 只眼接受了单纯的房角镜辅助经巩膜小梁切开术，49 只眼在同一手术时间接受了房角镜辅助经巩膜小梁切开术+白内障摘除术。在所有随访中，总体平均随访眼压与术前平均眼压之间存在统计学显著差异（p<0.001）。当评估治疗范围时，接受 360°扩展的患者的平均眼压与其他扩展的患者相比没有统计学显著降低。前房积血是 50 只眼（50%）出现的唯一并发症，但所有患者在 4 周内均自发缓解。由于眼压控制不佳，共有 26 只眼（26%）需要额外进行常规小梁切除术，尤其是那些之前接受过玻璃体视网膜手术的患者。
房角镜辅助经巩膜小梁切开术除了是一种明显安全的手术外，即使在外科医生的初始学习曲线期间，也能取得令人满意的成功率。该技术在降低眼压和药物负担方面有效。
