Berner Augenklinik, Zieglerstrasse 29, CH-3007, Bern, Switzerland.
Swiss Eye Institute, Rotkreuz, Switzerland.
Graefes Arch Clin Exp Ophthalmol. 2023 Oct;261(10):2917-2925. doi: 10.1007/s00417-023-06063-8. Epub 2023 May 5.
To compare the postoperative intraocular pressure (IOP) after ab interno trabeculectomy (AIT; trabectome surgery) alone or combined with cyclodialysis ab interno (AITC).
Forty-three eyes with insufficiently controlled open-angle glaucoma were included in this consecutive case series. All eyes received AIT, combined with phacoemulsification and IOL-implantation in phakic instances, with or without additional cyclodialysis ab interno. Postoperative visual acuity, IOP, number of IOP-lowering medications and complications were registered over 12 months.
A total of 19 eyes (14 patients) received AIT and 24 (19 patients) received AITC. Both groups were comparable for baseline IOP (AIT: 19.7 ± 8.2 mmHg; AITC: 19.4 ± 6.8 mmHg; p = 0.96), there was a comparable IOP reduction after 6 months (AIT: - 3.8 ± 12.3, median (interquartile range (IQR)): - 3.8 (- 7.8-4.8) mmHg; AITC: - 4.9 ± 8.3, median (IQR): - 2.0 (- 10.8-2.0) mmHg; p = 0.95) and 12 months (AIT: - 4.3 ± 6.6, median (IQR): - 4.0 (- 8.0 to - 1.0) mmHg; AITC: - 3.7 ± 6.7, median (IQR): - 1.5 (- 5.5 to - 0.5) mmHg; p = 0.49). While final visual acuity was similar between the groups, they differed regarding topical IOP-lowering medications (baseline: AIT 2.9 ± 1.2 and AITC 2.9 ± 1.2; 1 year after surgery: AIT 2.6 ± 1.5 (p = 0.16) and AITC 1.3 ± 1.3; p < 0.001)). Depending on the definition, a complete or qualified success of 33.4-45.8% was achieved in AITC compared to 15.8-21.1% in AIT.
The additional suprachoroidal outflow when AIT is combined with cyclodialysis ab interno (AITC) seems to result in an additional drug sparing effect for at least 1 year without critical safety signals. Thus, AITC might be further investigated prospectively prior to advocating its use in routine minimally invasive glaucoma surgery.
比较单纯内路小梁切开术（AIT；trabectome 手术）与内路小梁切开联合睫状体冷凝术（AITC）术后的眼内压（IOP）。
本连续病例系列研究纳入了 43 只眼压控制不佳的开角型青光眼眼。所有眼均接受 AIT，并在有晶状体眼行超声乳化白内障吸除术联合人工晶状体植入术，在无晶状体眼行白内障超声乳化吸除术联合人工晶状体植入术，同时或不联合内路小梁切开联合睫状体冷凝术。术后 12 个月内记录视力、IOP、降眼压药物的数量和并发症。
共 19 只眼（14 例）接受 AIT，24 只眼（19 例）接受 AITC。两组基线 IOP 相当（AIT：19.7±8.2mmHg；AITC：19.4±6.8mmHg；p=0.96），术后 6 个月的 IOP 降低程度也相似（AIT：-3.8±12.3mmHg，中位数（四分位距（IQR））：-3.8（-7.8～4.8）mmHg；AITC：-4.9±8.3mmHg，中位数（IQR）：-2.0（-10.8～2.0）mmHg；p=0.95）和 12 个月时（AIT：-4.3±6.6mmHg，中位数（IQR）：-4.0（-8.0～-1.0）mmHg；AITC：-3.7±6.7mmHg，中位数（IQR）：-1.5（-5.5～-0.5）mmHg；p=0.49）。虽然两组最终视力相似，但局部降眼压药物的使用情况不同（基线：AIT 2.9±1.2 和 AITC 2.9±1.2；术后 1 年：AIT 2.6±1.5（p=0.16）和 AITC 1.3±1.3；p<0.001））。根据不同的定义，AITC 的完全或有条件成功率为 33.4%-45.8%，而 AIT 为 15.8%-21.1%。
与单纯 AIT 相比，内路小梁切开联合睫状体冷凝术（AITC）时增加的脉络膜房水外流似乎至少在 1 年内具有额外的药物节省效应，且没有明显的安全信号。因此，在提倡将其用于常规微创青光眼手术之前，可能需要前瞻性地进一步研究 AITC。
