Hospital Universitário Onofre Lopes, Natal, RN, Brazil.
Department of Glaucoma, Instituto de Olhos Ciências Médicas, Belo Horizonte, MG, Brazil.
Arq Bras Oftalmol. 2021 Nov 29;85(4):344-350. doi: 10.5935/0004-2749.20220052. eCollection 2021.
To investigate the reduction in corneal endothelial cell density associated with gonioscopy-assisted transluminal trabeculotomy (GATT) in a short-term follow-up period.
A retrospective analysis of the medical charts of patients with open-angle glaucoma who underwent gonioscopy-assisted transluminal trabeculotomy isolated or combined with phacoemulsification (phaco-gonioscopy-assisted transluminal trabeculotomy) was conducted. Patients who underwent phacoemulsification alone were included as controls. The endothelial cell density data (assessed using a specular microscope) before and at the first month after operation were collected and then compared.
Sixty-two eyes previously treated with gonioscopy-assisted transluminal trabeculotomy (gonioscopy-assisted transluminal trabeculotomy, n=39 eyes; phaco-gonioscopy-assisted transluminal trabeculotomy, n=23 eyes) fulfilled the inclusion criteria. The mean age of the study patients was 61.3 ± 18.4 years in the stand-alone gonioscopyassisted transluminal trabeculotomy group and 60.4 ± 11.9 in phaco-gonioscopy-assisted transluminal trabeculotomy group. Men comprised 66.6% of the patients in the isolated gonioscopyassisted transluminal trabeculotomy group and 56.5% of those in the phaco-gonioscopy-assisted transluminal trabeculotomy group. The mean visual field defects (mean deviation index) were -13.9 ± 9.2 and -10.3 ± 7.7 dB in the isolated gonioscopy-assisted and phaco-gonioscopy-assisted transluminal trabeculotomy groups, respectively. The patients in the former group presented a mean endothelial cell density reduction of 28.8 cells/mm² (1.31%; p=0.467). In the latter group, the mean endothelial cell density loss was 89.4 cells/mm² (4.36%; p=0.028). The control eyes (23 patients) presented a mean endothelial cell density change of 114.1 ± 159.8 cells/mm² (4.41%; p=0.505). The endothelial cell density reduction in the phaco-gonioscopy-assisted transluminal trabeculotomy group was not significantly different from that in the controls (p=0.81).
Gonioscopy-assisted transluminal trabeculotomy appears to be a safe procedure for the corneal endothelial cell layer when performed either isolated or combined with cataract extraction in a short-term follow-up period.
研究在短期随访期间，与房角镜辅助经小梁切开术（GATT）相关的角膜内皮细胞密度降低。
对接受房角镜辅助经小梁切开术（单纯 GATT 治疗组 39 眼，超声乳化白内障吸除术联合 GATT 治疗组 23 眼）或单纯超声乳化白内障吸除术治疗的开角型青光眼患者的病历进行回顾性分析。收集并比较术前和术后 1 个月的内皮细胞密度数据（使用共焦显微镜评估）。
62 只眼符合纳入标准，其中单纯 GATT 治疗组 39 只眼，超声乳化白内障吸除术联合 GATT 治疗组 23 只眼。单纯 GATT 治疗组患者的平均年龄为 61.3±18.4 岁，超声乳化白内障吸除术联合 GATT 治疗组为 60.4±11.9 岁。单纯 GATT 治疗组中男性占 66.6%，超声乳化白内障吸除术联合 GATT 治疗组中男性占 56.5%。单纯 GATT 治疗组和超声乳化白内障吸除术联合 GATT 治疗组的平均视野缺损（平均偏差指数）分别为-13.9±9.2dB 和-10.3±7.7dB。前者的平均内皮细胞密度降低了 28.8 个细胞/mm²（1.31%；p=0.467），后者降低了 89.4 个细胞/mm²（4.36%；p=0.028）。对照组（23 例）的平均内皮细胞密度变化为 114.1±159.8 个细胞/mm²（4.41%；p=0.505）。超声乳化白内障吸除术联合 GATT 治疗组的内皮细胞密度降低与对照组相比差异无统计学意义（p=0.81）。
在短期随访期间，房角镜辅助经小梁切开术单独或联合白内障摘除术对角膜内皮细胞层似乎是一种安全的手术方式。
