Yazdani Shahin, Pakravan Mohammad, Gerami Ebrahim, Doozandeh Azadeh, Esfandiari Hamed, Sharifipour Farideh
Ocular Tissue Engineering Research Center.
Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Glaucoma. 2022 May 1;31(5):346-350. doi: 10.1097/IJG.0000000000001981. Epub 2022 Jan 10.
Trabeculotomy (T) alone is as safe and effective as combined trabeculotomy-trabeculectomy (TT) in patients with primary congenital glaucoma (PCG) and requires significantly fewer examinations under anesthesia in the postoperative period.
The purpose of this study was to compare the outcomes of T and combined TT as the initial surgical procedure for patients with PCG.
In this retrospective study, medical records of patients who had undergone T or TT as the initial procedure for PCG were reviewed. The primary outcome measure was a surgical success, defined as 5≤ intraocular pressure (IOP) ≤21 mm Hg, IOP reduction of at least 20% with no need for further glaucoma surgery. Secondary outcome measures were the number of glaucoma medications and complications.
A total of 134 eyes from 134 patients with a mean follow-up of 8±6.6 years were included consisting of 106 and 28 eyes, which had undergone T and TT, respectively. Success rates were comparable with both surgical procedures at 1, 2, 3, 4, and 5 years with no statistically significant difference. IOP was significantly decreased from 27.5±4.2 mm Hg preoperatively to 15.62±3.4 mm Hg at the 5-year follow-up visit in the T group and from 25.3±6.5 to 17.1±3.2 mm Hg in the TT group (P=0.1) there was no significant difference between the 2 groups in the number of glaucoma medications (P=0.2). Patients in the T group required significantly fewer examinations under anesthesia than the TT group (7.3±4.4 vs. 10.1±3.9, P=0.04).
Trabeculotomy alone seems as effective as combined trabeculotomy-trabeculectomy and may significantly reduce exposure to anesthesia in primary congenital glaucoma patients.
对于原发性先天性青光眼（PCG）患者，单纯小梁切开术（T）与小梁切开术 - 小梁切除术（TT）联合手术一样安全有效，且术后需要的麻醉下检查显著减少。
本研究旨在比较T和TT联合手术作为PCG患者初始手术的效果。
在这项回顾性研究中，回顾了接受T或TT作为PCG初始手术患者的病历。主要结局指标是手术成功，定义为眼压（IOP）≤21 mmHg且降低至少20%，无需进一步的青光眼手术。次要结局指标是青光眼药物使用数量和并发症。
共纳入134例患者的134只眼，平均随访8±6.6年，其中分别有106只眼和28只眼接受了T和TT手术。在1、2、3、4和5年时，两种手术的成功率相当，无统计学显著差异。T组眼压从术前的27.5±4.2 mmHg显著降至5年随访时的15.62±3.4 mmHg，TT组从25.3±6.5降至17.1±3.2 mmHg（P = 0.1），两组青光眼药物使用数量无显著差异（P = 0.2）。T组患者所需的麻醉下检查明显少于TT组（7.3±4.4 vs. 10.1±3.9，P = 0.04）。
单纯小梁切开术似乎与小梁切开术 - 小梁切除术联合手术一样有效，并且可能显著减少原发性先天性青光眼患者的麻醉暴露。
