Department of Ophthalmology, Federal University of Rio Grande do Norte, Natal.
Department of Ophthalmology, University of Campina.
J Glaucoma. 2022 Jun 1;31(6):443-448. doi: 10.1097/IJG.0000000000002025. Epub 2022 Mar 29.
Our results suggest gonioscopy-assisted transluminal trabeculotomy (GATT) as an effective and safe option for the surgical management of open-angle glaucoma (OAG). Older age was the only risk factor for failure in our analysis.
To report 12-month clinical outcomes, safety profile and success predictors of GATT in patients with OAG.
A retrospective study of patients (18 y old and above) with medically uncontrolled OAG who underwent GATT as a solo procedure or combined with phacoemulsification (PHACO-GATT) between January 2018 and January 2020. Success at 12 months (primary outcome) was defined as intraocular pressure (IOP) <15 mm Hg, with an IOP reduction of at least 20%, OR a reduction of at least 2 glaucoma medications, compared with baseline. Secondary outcomes were success predictors and safety parameters.
A total of 73 eyes (GATT=38; PHACO-GATT=35) from 58 patients with a mean age of 54.8±11.6 years were included. Overall, after 12 months of follow-up, the mean IOP was reduced from 24.9±8.5 to 12.1±2.1 mm Hg (P<0.001). The mean number of glaucoma medications was reduced from 3.5±0.7 to 1.2±1.2 (P<0.001). The success rate was 87% at 12 months, with no significant differences between GATT (85%) and PHACO-GATT (91%) eyes (P=0.330). Age was the only factor significantly associated with surgical success (hazard ratio=1.35; P=0.012; after adjusting for preoperative IOP and number of glaucoma medications). Patients older than 60 years had a significant greater chance of failure (hazard ratio=10.96; P=0.026) compared with those younger than 60 years. The most common postoperative complication was transient hyphema (39%; median duration, 5 d). No sight-threatening adverse event was documented.
GATT was effective and safe at lowering IOP with or without cataract extraction in OAG. Patients 60 years or older had a higher risk of failure compared with those younger in age.
我们的研究结果表明，房角镜辅助经巩膜小梁切开术（GATT）是治疗开角型青光眼（OAG）的一种有效且安全的选择。在我们的分析中，年龄较大是唯一的失败风险因素。
报告 GATT 治疗 OAG 患者 12 个月的临床结果、安全性概况和成功预测因素。
对 2018 年 1 月至 2020 年 1 月期间接受 GATT 单一手术或与超声乳化白内障吸除术（PHACO-GATT）联合治疗的年龄在 18 岁及以上、药物控制不佳的 OAG 患者进行回顾性研究。主要结局为 12 个月时的成功率（定义为眼压（IOP）<15mmHg，IOP 降低至少 20%，或至少降低 2 种降眼压药物）。次要结局为成功预测因素和安全性参数。
纳入了 58 例患者的 73 只眼（GATT=38 只；PHACO-GATT=35 只），平均年龄为 54.8±11.6 岁。总的来说，在 12 个月的随访后，平均 IOP 从 24.9±8.5mmHg 降至 12.1±2.1mmHg（P<0.001）。平均降眼压药物数量从 3.5±0.7 降至 1.2±1.2（P<0.001）。12 个月时的成功率为 87%，GATT（85%）和 PHACO-GATT（91%）之间无显著差异（P=0.330）。年龄是唯一与手术成功显著相关的因素（风险比=1.35；P=0.012；在调整了术前 IOP 和降眼压药物数量后）。年龄大于 60 岁的患者手术失败的几率显著高于年龄小于 60 岁的患者（风险比=10.96；P=0.026）。最常见的术后并发症是短暂性前房积血（39%；中位持续时间为 5 天）。没有发生威胁视力的不良事件。
在 OAG 中，GATT 联合或不联合白内障摘除术降低眼压既有效又安全。年龄 60 岁或以上的患者手术失败的风险高于年龄较轻的患者。
