Correia Barbosa Renato, Gonçalves Rita, Bastos Ricardo, Alves Pereira Sara, Basto Rita, Viana Ana Rita, Tenedório Paula
Ophthalmology Department, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.
Clin Ophthalmol. 2023 Jun 6;17:1619-1627. doi: 10.2147/OPTH.S405837. eCollection 2023.
Glaucoma is the second leading cause of vision loss worldwide. The reduction of intraocular pressure remains the backbone of its therapy. Among surgical techniques for its treatment, deep non-penetrating sclerotomy is the most widely practiced non-penetrating surgery. The purpose of this study was to evaluate the long-term efficacy and safety of deep non-penetrating sclerotomy compared to standard trabeculectomy in patients with open-angle glaucoma.
Retrospective study including 201 eyes with open-angle glaucoma. Closed-angle and neovascular cases were excluded. Absolute success was considered when intraocular pressure under 18 mmHg, or a reduction of at least 20% in patients with a baseline intraocular pressure below 22 mmHg, was obtained after 24 months, without the use of medication. Qualified success was considered when those targets were met with or without the use of hypotensive medication.
Deep non-penetrating sclerectomy showed a slightly lower long-term hypotensive effect compared to standard trabeculectomy, with significant differences at 12 months, but not at 24 months of follow-up. The absolute and qualified success rates were 51.85% and 65.43% for the trabeculectomy group and 50.83% and 60.83% for the deep non-penetrating sclerectomy, without significant differences. Regarding postoperative complications, mainly due to postoperative hypotonia, or related to the filtration bleb, they were significantly different between groups, with 10.8% and 24.7%, in deep-nonpenetrating sclerectomy and trabeculectomy groups, respectively.
Deep non-penetrating sclerectomy seems to be an effective and safe surgical option for patients with open-angle glaucoma unable to be controlled by non-invasive strategies. Data suggests that the intraocular pressure-lowering effect of this technique may be marginally lower than that of trabeculectomy, but the achieved efficacy outcomes were similar, with a significantly lower risk of complications.
青光眼是全球视力丧失的第二大主要原因。降低眼压仍然是其治疗的核心。在其治疗的手术技术中，深层非穿透性巩膜切开术是应用最广泛的非穿透性手术。本研究的目的是评估与标准小梁切除术相比，深层非穿透性巩膜切开术治疗开角型青光眼患者的长期疗效和安全性。
回顾性研究纳入201例开角型青光眼患者。排除闭角型和新生血管性病例。当24个月后眼压低于18 mmHg，或基线眼压低于22 mmHg的患者眼压降低至少20%，且未使用药物时，视为绝对成功。当使用或未使用降压药物达到这些目标时，视为合格成功。
与标准小梁切除术相比，深层非穿透性巩膜切开术的长期降压效果略低，在随访12个月时有显著差异，但在24个月时无显著差异。小梁切除术组的绝对成功率和合格成功率分别为51.85%和65.43%，深层非穿透性巩膜切开术组为50.83%和60.83%，无显著差异。关于术后并发症，主要是由于术后低眼压或与滤过泡相关，两组之间有显著差异，深层非穿透性巩膜切开术组和小梁切除术组分别为10.8%和24.7%。
对于无法通过非侵入性策略控制的开角型青光眼患者，深层非穿透性巩膜切开术似乎是一种有效且安全的手术选择。数据表明，该技术的降眼压效果可能略低于小梁切除术，但取得的疗效结果相似，并发症风险显著更低。
