Otori Yasumasa, Matsuoka Takanori, Kumoi Miho, Tachibana Eri, Tsujino Chieko, Matsuda Satoshi
Department of Ophthalmology, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
Clin Ophthalmol. 2021 Jul 30;15:3213-3220. doi: 10.2147/OPTH.S322166. eCollection 2021.
To compare the outcomes of ab interno suture trabeculotomy (AbI-TLO) and ab externo metal trabeculotomy (AbE-TLO) in adult patients with glaucoma aged over 40 years.
A retrospective chart review was conducted, including adult patients with glaucoma who underwent AbI-TLO or AbE-TLO between January 2015 and June 2019. A single surgeon (YO) performed all the operations. Eighty-one patients (81 eyes) were included in this study. Surgical success was defined as a postoperative intraocular pressure (IOP) of ≤18 mmHg and an IOP reduction of ≥20% from the preoperative IOP, without requiring additional glaucoma surgery. Success rates were assessed using Kaplan-Meier survival curves and log-rank (Mantel-Cox) tests, while risk factors were analyzed using the Cox proportional hazards model.
Forty-nine patients who underwent AbI-TLO and 32 patients who underwent AbE-TLO were studied; the preoperative IOPs were 27.9 ± 7.3 (mean ± standard deviation) mmHg and 25.6 ± 8.1 mmHg in the AbI-TLO and AbE-TLO groups, respectively (p=0.217). The 12-month postoperative IOPs were 15.8 ± 4.0 mmHg and 16.3 ± 4.2 mmHg in the AbI-TLO and AbE-TLO groups, respectively (p=0.724). The surgical success rates at 12 months were 77.6% and 62.5% in the AbI-TLO and AbE-TLO groups, respectively (p=0.144). Postoperative hyphema with level formation and ocular hypertension over 30 mmHg were observed in 22.4% and 26.5% of patients in the AbI-TLO group and 18.8% and 12.5% of those in the AbE-TLO group, respectively. Stepwise multivariate Cox regression analysis showed that a longer axial length was a risk factor for surgical failure (hazard ratio: 2.030; p=0.042).
AbI-TLO and AbE-TLO had similar surgical outcomes and postoperative complications. A longer axial length was associated with an insufficient IOP reduction.
比较40岁以上成年青光眼患者内行小梁切开术（AbI-TLO）和外路金属小梁切开术（AbE-TLO）的手术效果。
进行一项回顾性病历审查，纳入2015年1月至2019年6月期间接受AbI-TLO或AbE-TLO的成年青光眼患者。所有手术均由单一外科医生（YO）完成。本研究共纳入81例患者（81只眼）。手术成功定义为术后眼压（IOP）≤18 mmHg且眼压较术前降低≥20%，无需额外的青光眼手术。使用Kaplan-Meier生存曲线和对数秩（Mantel-Cox）检验评估成功率，同时使用Cox比例风险模型分析危险因素。
对49例行AbI-TLO的患者和32例行AbE-TLO的患者进行了研究；AbI-TLO组和AbE-TLO组术前眼压分别为27.9±7.3（均值±标准差）mmHg和25.6±8.1 mmHg（p=0.217）。AbI-TLO组和AbE-TLO组术后12个月眼压分别为15.8±4.0 mmHg和16.3±4.2 mmHg（p=0.724）。AbI-TLO组和AbE-TLO组12个月时的手术成功率分别为77.6%和62.5%（p=0.144）。AbI-TLO组分别有22.4%和26.5%的患者出现伴有液平面形成的术后前房积血和眼压超过30 mmHg的高眼压，AbE-TLO组分别为18.8%和12.5%。逐步多因素Cox回归分析显示，眼轴长度较长是手术失败的危险因素（风险比：2.030；p=0.042）。
AbI-TLO和AbE-TLO的手术效果和术后并发症相似。眼轴长度较长与眼压降低不足有关。
