Berman Tasmin, Somerville Tobi, Choudhary Anshoo
St Pauls Eye Unit, Liverpool University Hospital, Liverpool, UK.
Graefes Arch Clin Exp Ophthalmol. 2022 Jun;260(6):1995-2002. doi: 10.1007/s00417-021-05497-2. Epub 2021 Nov 24.
To assess the outcomes of viscocanalostomy and phaco-viscocanalostomy in patients with narrow angle glaucoma at a single tertiary eye centre.
All patients undergoing viscocanalostomy for narrow angle glaucoma between June 2010 and June 2017 with a minimum follow-up of 12 months were included. Data was analysed from a prospectively maintained surgical outcome database. Primary outcome was a change in intraocular pressure (IOP). Secondary outcomes were changes in LogMAR visual acuity, number of eye drops, post-operative complications and further surgical interventions. Success was defined at two IOP cut-off points: IOP ≤ 21 mmHg and IOP ≤ 15 mmHg with (qualified success) or without (complete success) drops. Failure was any repeat glaucoma surgery or loss of light perception.
Seventy eyes of 46 patients with a mean follow-up of 41.31 months (range 12-60 months) were included. Mean IOP changed from 25.7 ± 9.6 to 15.2, 15.6, 14.6, 13.8 and 14.0 mmHg at 1, 2, 3, 4 and 5 years post-operatively. Drops reduced from 3.2 ± 1.1 pre-operatively to 0.5 at 1 year and 1.1 at all time points thereafter. Qualified success for an IOP ≤ 21 mmHg was achieved in 94.2%, 88.1%, 92.5%, 91.1% and 92.0% and complete success in 63.8%, 37.3%, 30.2%, 22.2% and 24.0% in years 1 to 5, respectively. Qualified success for an IOP ≤ 15 mmHg was achieved in 53.6%, 60.9%, 69.8%, 68.9% and 64.0% and complete success in 39.1%, 26.9%, 22.6%, 20.0% and 8.0% in years 1 to 5, respectively. IOP was significantly lower at all examined post-operative time points (41.1%, 39.3%, 43.3%, 46.4% and 45.3% at years 1 to 5, respectively, p < 0.001 at all time points). Four eyes (5.7%) failed to meet any of the success criteria. Of these, 3 eyes (4.3%) required further glaucoma surgery and one eye (1.4%) progressed to no perception of light at 48 months. No patients had an IOP ≤ 5 mmHg on two consecutive occasions after 3 months.
Viscocanalostomy and phaco-viscocanalostomy are a safe and effective surgical option in the management of chronic narrow angle glaucoma.
在一家三级眼科中心评估粘性小管切开术和超声乳化-粘性小管切开术治疗窄角型青光眼患者的疗效。
纳入2010年6月至2017年6月期间接受粘性小管切开术治疗窄角型青光眼且随访至少12个月的所有患者。数据来自前瞻性维护的手术结果数据库。主要结局是眼压（IOP）的变化。次要结局是LogMAR视力、滴眼液数量、术后并发症及进一步手术干预的变化。成功定义为两个眼压切点：眼压≤21 mmHg且使用（合格成功）或不使用（完全成功）滴眼液；眼压≤15 mmHg。失败定义为任何重复的青光眼手术或光感丧失。
纳入46例患者的70只眼，平均随访41.31个月（范围12 - 60个月）。术后1、2、3、4和5年时，平均眼压分别从25.7±9.6降至15.2、15.6、14.6、13.8和14.0 mmHg。术前滴眼液平均为3.2±1.1种，术后1年降至0.5种，此后各时间点均为1.1种。第1至5年，眼压≤21 mmHg的合格成功率分别为94.2%、88.1%、92.5%、91.1%和92.0%，完全成功率分别为63.8%、37.3%、30.2%、22.2%和24.0%。第1至5年，眼压≤15 mmHg的合格成功率分别为53.6%、60.9%、69.8%、68.9%和64.0%，完全成功率分别为39.1%、26.9%、22.6%、20.0%和8.0%。所有术后检查时间点眼压均显著降低（第1至5年分别为41.1%、39.3%、43.3%、46.4%和45.3%，所有时间点p<0.001）。4只眼（5.7%）未达到任何成功标准。其中，3只眼（4.3%）需要进一步的青光眼手术，1只眼（1.4%）在48个月时进展为无光感。3个月后没有患者连续两次眼压≤5 mmHg。
粘性小管切开术和超声乳化-粘性小管切开术是治疗慢性窄角型青光眼的安全有效的手术选择。
