Glaucoma Associates of Texas, Dallas, TX.
Bascom Palmer Eye Institute, Miami, FL.
J Glaucoma. 2022 Jan 1;31(1):54-59. doi: 10.1097/IJG.0000000000001949.
Glaucoma is a well-known sequelae of corneal transplant surgery and is a leading cause of visual loss in this patient group. We evaluated the performance and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in this population.
Noncomparative retrospective case series.
Consecutive eyes of patients receiving the GATT procedure for uncontrolled intraocular pressure (IOP) following corneal transplant surgery from 2016 to 2019.
Retrospective analysis of eyes with a history of prior corneal transplant undergoing GATT at Glaucoma Associates of Texas between 2016 and 2019 was performed. Data included IOP, patient demographics, preoperative and postoperative medications, preoperative and postoperative corneal procedures, complications, and need for reoperation for IOP control.
IOP reduction and medication use following the procedure.
Thirty-nine eyes of 32 patients with prior corneal transplant surgery underwent a GATT procedure. Prior corneal surgery included penetrating keratoplasty (59.0%), Descemet's stripping endothelial keratoplasty (35.9%), Descemet's membrane endothelial keratoplasty (2.6%), and deep anterior lamellar keratoplasty (2.6%). Patient age ranged from 24 to 94 years (mean 68.0 y) with 44% female and 81% Caucasian. The majority of patients had secondary open angle glaucoma (64.1%). There was a significant reduction in IOP and number of medications at all postoperative time points after censoring patients requiring reoperation to control IOP (P<0.001). At 24 months the pressure decreased from baseline of 30.9±11.5 to 13.9±4.7 mm Hg. Medications decreased from 4.2±1.0 medications at baseline to 0.6±1.0 at 24 months. Visual acuities decreased significantly over the first postsurgical month (all P<0.05), but these recovered at subsequent follow-up visits with 2-Snellen line improvements exceeding losses from month 3 to 36. Seven eyes required reoperation for uncontrolled glaucoma at a median of 8.5 months (range: 1.6 to 16.2 mo) after GATT. The cumulative proportion of eyes undergoing repeat cornea surgery was 2.6%, 2.6%, and 14.3% at 12, 24, and 36 months post-GATT, respectively.
This case series describes a group of glaucoma patients, with a history of prior corneal surgery, that were safely and successfully treated with GATT. While classically traditional glaucoma surgeries are considered the standard of care for eyes following corneal transplant surgery, GATT should be considered as a reasonable, safe and effective alternative for surgically lowering IOP.
青光眼是角膜移植手术后的一种已知后遗症，也是该患者群体视力丧失的主要原因。我们评估了在该人群中进行房角切开术辅助经小梁切开术（GATT）的效果和安全性。
非对照回顾性病例系列。
2016 年至 2019 年期间，因角膜移植术后眼压控制不佳而接受 GATT 手术的患者连续眼。
对 2016 年至 2019 年间在德克萨斯州青光眼协会接受 GATT 手术的既往角膜移植患者进行了回顾性分析。数据包括眼压、患者人口统计学、术前和术后用药、术前和术后角膜手术、并发症以及为控制眼压而再次手术的需要。
术后眼压降低和药物使用情况。
32 例既往角膜移植手术患者的 39 只眼接受了 GATT 手术。既往角膜手术包括穿透性角膜移植术（59.0%）、Descemet 撕囊内皮角膜移植术（35.9%）、Descemet 膜内皮角膜移植术（2.6%）和深层前板层角膜移植术（2.6%）。患者年龄 24 至 94 岁（平均 68.0 岁），女性占 44%，白种人占 81%。大多数患者患有继发性开角型青光眼（64.1%）。在排除因眼压控制需要再次手术的患者后，所有术后时间点的眼压和药物数量均显著降低（P<0.001）。24 个月时，眼压从基线的 30.9±11.5mmHg 降至 13.9±4.7mmHg。药物从基线时的 4.2±1.0 种减少到 24 个月时的 0.6±1.0。术后第一个月视力明显下降（所有 P<0.05），但随后的随访中视力恢复，从术后 3 个月到 36 个月，视力提高超过了视力损失。7 只眼在 GATT 后中位时间 8.5 个月（范围：1.6 至 16.2 个月）因青光眼未控制而需要再次手术。GATT 后 12、24 和 36 个月时，再次行角膜手术的累积比例分别为 2.6%、2.6%和 14.3%。
本病例系列描述了一组既往有角膜手术史的青光眼患者，他们通过 GATT 安全有效地得到了治疗。虽然传统的青光眼手术被认为是角膜移植术后的标准治疗方法，但 GATT 也应被视为一种合理、安全和有效的降低眼压的替代方法。
