改良小梁切开术与小梁切除术治疗开角型青光眼的长期疗效和安全性比较
Long-Term Efficacy and Safety of Modified Canaloplasty Versus Trabeculectomy in Open-Angle Glaucoma.
作者信息
Stingl Julia V, Wagner Felix M, Liebezeit Sarah, Baumgartner Raphael, Spät Helene, Schuster Alexander K, Prokosch Verena, Grehn Franz, Hoffmann Esther M
机构信息
Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany.
Regiomed Clinic Masserberg, 98666 Masserberg, Germany.
出版信息
Life (Basel). 2023 Feb 13;13(2):516. doi: 10.3390/life13020516.
BACKGROUND
To evaluate the long-term efficacy and safety of modified canaloplasty versus trabeculectomy in open-angle glaucoma.
METHODS
In total, 210 subjects with open-angle glaucoma were included. 70 were treated with Mitomycin C-augmented modified canaloplasty with enhanced subconjunctival filtration and 140 with Mitomycin C-augmented trabeculectomy. Cases were matched 1:2 by sex and age.
RESULTS
In canaloplasty and trabeculectomy groups, 61.4% and 57.9% of participants were female. Mean age was 60.0 ± 13.9 and 63.0 ± 12.2 years, median follow-up time was 4.6 [IQR 4.3, 5.05] years and 5.8 [IQR 5.4, 6.3]. Strict success was achieved in 20.0% and 56.4%, complete success in 24.3% and 66.4%, and qualified success in 34.3% and 73.6% (each < 0.001). Kaplan-Meier survival analysis showed a better survival probability for trabeculectomy than for canaloplasty ( < 0.001) and Cox regression analysis revealed an HR of 6.03 (95%-CI 3.66, 9.93, < 0.001) after canaloplasty. Trabeculectomy showed superiority in terms of IOP decrease (9.2 ± 7.9 mmHg vs. 13.7 ± 10.4 mmHg, = 0.002), use of AGM (50.0% vs. 10.7%, < 0.001), and the number of revision surgeries (41.4% vs. 21.4%, = 0.004). Occurrence of complications was similar in both groups (14.5% vs. 7.5%, = 0.19).
CONCLUSIONS
Trabeculectomy showed superiority in efficacy and equality in safety compared to modified canaloplasty.
背景
评估改良小梁切开术与小梁切除术治疗开角型青光眼的长期疗效和安全性。
方法
共纳入210例开角型青光眼患者。70例接受丝裂霉素C辅助的改良小梁切开术并加强结膜下滤过，140例接受丝裂霉素C辅助的小梁切除术。病例按性别和年龄1:2匹配。
结果
小梁切开术组和小梁切除术组中，女性参与者分别占61.4%和57.9%。平均年龄分别为60.0±13.9岁和63.0±12.2岁，中位随访时间分别为4.6[四分位间距4.3，5.05]年和5.8[四分位间距5.4，6.3]年。严格成功率分别为20.0%和56.4%，完全成功率分别为24.3%和66.4%，合格成功率分别为34.3%和73.6%（均P<0.001）。Kaplan-Meier生存分析显示小梁切除术的生存概率优于小梁切开术（P<0.001），Cox回归分析显示小梁切开术后的风险比为6.03（95%置信区间3.66，9.93，P<0.001）。小梁切除术在降低眼压方面更具优势（9.2±7.9 mmHg对13.7±10.4 mmHg，P=0.002），使用抗青光眼药物方面（50.0%对10.7%，P<0.001），以及再次手术次数方面（41.4%对21.4%，P=0.004）。两组并发症的发生率相似（14.5%对7.5%，P=0.19）。
结论
与改良小梁切开术相比，小梁切除术在疗效上更具优势，在安全性上相当。
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