Sigona Mark, Saravanan Amrita, Pipis Spyros, Masood Imran
Birmingham Midland Eye Centre, SWBH NHS Trust, Birmingham Institute of Glaucoma Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham, England.
J Glaucoma. 2022 Sep 1;31(9):e83-e86. doi: 10.1097/IJG.0000000000002058. Epub 2022 Jun 3.
We describe 4 cases of eyes initially treated with phacoemulsification and iStent trabecular microbypass (Glaukos Corporation). These patients subsequently required further surgery and were successfully treated with the removal of the iStent device followed by gonioscopy-assisted transluminal trabeculotomy (GATT), using the iTrack catheter (Ellex Medical Lasers Ltd). Three of the cases had prior first-generation iStent (G1), and 1 had prior second-generation iStent (G2). This case series demonstrates that in selected cases, a further angle procedure in the form of a GATT can show efficacy and durability in the medium term. Our patients had controlled intraocular pressures (IOPs) at 1-year post-GATT: 2 on IOP-lowering therapy and 2 without any IOP-lowering medications. Three patients had transient hyphema and 2 with high IOP in the immediate postoperative period. No patients experienced a decrease in best-corrected visual acuity postoperatively. To the best of our knowledge, there is no prior literature describing this surgical strategy. This series demonstrates that GATT could potentially be an effective procedure in the case of a failed initial iStent microtrabecular bypass.
我们描述了4例最初接受超声乳化白内障吸除术和iStent小梁微旁路手术（Glaukos公司）治疗的眼部病例。这些患者随后需要进一步手术，并通过使用iTrack导管（Ellex Medical Lasers Ltd）移除iStent装置，随后进行房角镜辅助经腔小梁切开术（GATT）成功治疗。其中3例曾植入第一代iStent（G1），1例曾植入第二代iStent（G2）。该病例系列表明，在某些特定病例中，以GATT形式进行的进一步房角手术在中期可显示出疗效和持久性。我们的患者在GATT术后1年眼压得到控制：2例接受降眼压治疗，2例未使用任何降眼压药物。3例患者术后短期内出现短暂性前房积血，2例术后眼压升高。术后无患者最佳矫正视力下降。据我们所知，此前尚无文献描述这种手术策略。该系列表明，在最初的iStent微小梁旁路手术失败的情况下，GATT可能是一种有效的手术方法。
