Legacy Devers Eye Institute and Discoveries In Sight Research Laboratories at Legacy Health, Portland.
Department of Osteopathic Medicine, Western University of Health Sciences, Lebanon, OR.
J Glaucoma. 2022 Jun 1;31(6):423-429. doi: 10.1097/IJG.0000000000002028. Epub 2022 Mar 29.
When compared with cataract surgery in glaucoma patients, trabecular micro-bypass and goniotomy resulted in a large decrease in the incidence of intraocular pressure (IOP) spikes, a modest effect on IOP, and a minimal effect on medication burden.
To compare changes in IOP and ocular hypotensive medications in 3 surgical cohorts: cataract surgery, cataract surgery with trabecular micro-bypass (cataract/trabecular), and cataract surgery with goniotomy (cataract/goniotomy).
We included 138 eyes diagnosed with open-angle glaucoma: (1) 84 eyes with cataract surgery alone, (2) 25 eyes with cataract/trabecular surgery, and (3) 29 eyes with cataract/goniotomy surgery. We compared the groups for postoperative IOP and the number of ocular hypotensive medications. We adjusted for preoperative IOP, and preoperative and postoperative number of ocular hypotensive medications. We defined an IOP spike as IOP ≥21 mm Hg and 10 mm Hg higher than preoperative on postoperative day 1.
All 3 surgeries showed a decrease in IOP (P≤0.004) and medication burden (P≤0.001) at 3 and 6 months postoperatively when compared with their own preoperative baselines. When compared with cataract surgery alone, cataract/trabecular and cataract/goniotomy had similar IOP lowering at 1 month postoperatively, and variable results at 3 and 6 months. The change in ocular hypotensive medications was not statistically different between the surgical groups at any postoperative visit. Cataract/trabecular and cataract/goniotomy decreased IOP on postoperative day 1, and had relative risk reduction of ~70% for IOP spikes (P≤0.001 for both).
Trabecular micro-bypass and goniotomy when added to cataract surgery resulted in a large decrease in IOP spikes, a modest effect on IOP, and a minimal effect on medication burden when compared with cataract surgery alone in glaucoma patients.
与青光眼患者的白内障手术相比，小梁微旁路和房角切开术可显著降低眼压（IOP）峰值的发生率，对 IOP 的影响适度，对药物负担的影响最小。
比较 3 个手术组（白内障手术、白内障联合小梁微旁路手术和白内障联合房角切开术）IOP 和降眼压药物的变化。
我们纳入了 138 只患有开角型青光眼的眼睛：（1）84 只仅接受白内障手术，（2）25 只接受白内障联合小梁旁路手术，（3）29 只接受白内障联合房角切开术。我们比较了各组术后的眼压和降眼压药物的数量。我们调整了术前眼压、术前和术后降眼压药物的数量。我们将眼压峰值定义为术后第 1 天的眼压≥21mmHg 和比术前高 10mmHg。
与自身术前基线相比，所有 3 种手术在术后 3 个月和 6 个月时均降低了 IOP（P≤0.004）和药物负担（P≤0.001）。与单纯白内障手术相比，白内障联合小梁旁路和白内障联合房角切开术在术后 1 个月时具有相似的降压效果，而在术后 3 个月和 6 个月时效果不同。在任何术后随访中，手术组之间的降眼压药物变化均无统计学差异。白内障联合小梁旁路和白内障联合房角切开术可降低术后第 1 天的眼压，并降低眼压峰值的相对风险（均为 P≤0.001）。
与单纯白内障手术相比，在青光眼患者中，当小梁微旁路和房角切开术联合白内障手术时，可显著降低眼压峰值的发生率，对眼压的影响适度，对药物负担的影响最小。
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