房角镜辅助经巩膜隧道小梁切开术治疗抗青光眼术后失败的开角型青光眼：两年结果。
Gonioscopy-assisted transluminal trabeculotomy for open-angle glaucoma with failed incisional glaucoma surgery: two-year results.
机构信息
Department of Ophthalmology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China.
Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
出版信息
BMC Ophthalmol. 2023 Mar 6;23(1):89. doi: 10.1186/s12886-023-02830-7.
BACKGROUND
To evaluate the safety and efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) in treating patients with open-angle glaucoma (OAG) who had failed prior incisional glaucoma surgery.
METHODS
A consecutive case series of OAG patients aged ≥ 18 who underwent GATT with previous failed glaucoma incision surgery was retrospectively analyzed. Main outcome measures included intraocular pressure (IOP), the number of glaucoma medications, surgical success rate, and occurrence of complications. Success was defined as an IOP of ≤ 21 mmHg and a reduction of IOP by 20% or more from baseline with (qualified success) or without (complete success) glaucoma medications. For eyes with preoperative IOP of < 21 mmHg on 3 or 4 glaucoma medications, postoperative IOP of ≤ 18 mmHg without any glaucoma medications was also defined as complete success.
RESULTS
Forty-four eyes of 35 patients (21 with juvenile-onset open-angle glaucoma and 14 with adult-onset primary open-angle glaucoma) with a median age of 38 years were included in this study. The proportion of eyes with 1 prior incisional glaucoma surgery was 79.5%, and the others had 2 prior surgeries. IOP decreased from 27.4 ± 8.8 mm Hg on 3.6 ± 0.7 medications preoperatively to 15.3 ± 2.7 mm Hg on 0.5 ± 0.9 medications at the 24-month visit (P < 0.001). The mean IOP and the number of glaucoma medications at each follow-up visit were lower than the baseline (all P < 0.001). At 24 months postoperatively, 82.1% of the eyes had IOP ≤ 18 mmHg (versus 15.9% preoperatively, P < 0.001), 56.4% reached IOP ≤ 15 mmHg (versus 4.6% preoperatively, P < 0.001), and 15.4% achieved IOP ≤ 12 mmHg (compared to none preoperatively, P = 0.009). While 95.5% of eyes took 3 or more medications preoperatively, 66.7% did not take glaucoma medication 24 months after GATT. Thirty-four (77.3%) eyes achieved IOP reduction greater than 20% on fewer medications. The complete and qualified success rates were 60.9% and 84.1%, respectively. No vision-threatening complications occurred.
CONCLUSIONS
GATT was safe and effective in treating refractory OAG patients who failed prior incisional glaucoma surgery.
背景
评估青光眼引流阀辅助经巩膜隧道小梁切开术（GATT）治疗既往抗青光眼手术失败的开角型青光眼（OAG）患者的安全性和疗效。
方法
对 35 例（21 例青少年开角型青光眼，14 例成人开角型原发性青光眼）44 只眼接受 GATT 治疗的 OAG 患者进行回顾性分析，这些患者既往均有抗青光眼手术失败史。主要观察指标包括眼压（IOP）、青光眼药物使用数量、手术成功率和并发症发生情况。成功定义为眼压≤21mmHg，IOP 较基线值降低 20%或以上（有或无降眼压药物）。术前 IOP 在 3 种或 4 种降眼压药物控制下＜21mmHg 的眼，术后无需任何降眼压药物，IOP ＜18mmHg 亦定义为完全成功。
结果
44 只眼中有 1 次抗青光眼手术失败史的占 79.5%，2 次失败史的占 20.5%。患者年龄中位数为 38 岁。术前IOP为 27.4±8.8mmHg，使用 3.6±0.7 种降眼压药物；术后 24 个月时IOP为 15.3±2.7mmHg，使用 0.5±0.9 种降眼压药物（P＜0.001）。在随访期间，所有患者的平均眼压和降眼压药物使用数量均低于基线值（均P＜0.001）。术后 24 个月时，82.1%（37/44）的眼眼压＜18mmHg（术前为 15.9%，P＜0.001），56.4%（25/44）的眼眼压＜15mmHg（术前为 4.6%，P＜0.001），15.4%（7/44）的眼眼压＜12mmHg（术前为 0%，P=0.009）。术前有 95.5%（42/44）的眼使用 3 种或更多种降眼压药物，术后 24 个月时 66.7%（29/44）的眼无需使用降眼压药物。34 只眼（77.3%）在减少药物种类的情况下，IOP 降幅＞20%。完全成功率和有效成功率分别为 60.9%（27/44）和 84.1%（37/44）。无视力威胁性并发症发生。
结论
GATT 治疗既往抗青光眼手术失败的难治性 OAG 患者安全有效。
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