比较超声乳化白内障吸除术联合双刀片前房角切开术（PEcK）或两个小梁支架植入术（ICE2）与睫状体光凝术的疗效。
Comparing Outcomes of Phacoemulsification and Endocyclophotocoagulation with Either Dual Blade Goniotomy (PEcK) or Two Trabecular Stents (ICE2).
作者信息
El Helwe Hani, Oberfeld Blake, Golsoorat Pahlaviani Fatemeh, Falah Henisk, Trzcinski Jonathan, Solá-Del Valle David
机构信息
Department of Ophthalmology, Harvard Medical School and Mass Eye and Ear, Boston, MA, USA.
出版信息
Clin Ophthalmol. 2023 Oct 3;17:2879-2888. doi: 10.2147/OPTH.S431356. eCollection 2023.
PURPOSE
To compare outcomes of phacoemulsification and endocyclophotocoagulation with either dual blade goniotomy (PEcK) or two trabecular stents (ICE2).
SETTING
Retrospective, nonrandomized comparative study from a level 3 triage center.
METHODS
One hundred and seventy charts and a total of 1294 visits were reviewed following either PEcK or ICE2 from 2018 to 2022. One hundred and twenty-eight patients had PEcK and 42 underwent ICE2. Patients with less than 30 days of follow-up were excluded. The mean follow-up time was 505 ± 308 days. Two Kaplan-Meier curves (KM) assessed survival with ≤ baseline medications while maintaining (1) [GIC - Goal IOP Criteria] IOP ≤ goal IOP or (2) [PRC - Percent Reduction Criteria] IOP reduction ≥ 20% with 5 mmHg ≤ IOP ≤ 21 mmHg for at least two consecutive visits. IOP and medication burden reduction were compared using a paired -test.
RESULTS
Most patients were Caucasian (65%) and had mild-stage glaucoma (43%). The most common glaucoma type was primary open-angle glaucoma (58%). Average age was 72.2 years at the time of surgery. Mean preoperative IOP was 17.58 ± 4.98 mmHg on 3.00 ± 1.41 medications in PEcK and 15.36 ± 3.58 mmHg on 1.81 ± 1.11 medications in ICE2 (p = 0.015 for IOP; p < 0.001 for medications). Under GIC, the success rate was significantly higher in PEcK at POM6 (69% vs 46%, p < 0.001) and POY1 (63% vs 36%, p < 0.001). Under PRC, the success rate was significantly higher in PEcK at POM6 (73% vs 61%, p = 0.031) and POY1 (67% vs 50%, p = 0.028). Mean reductions at POY1 were 5.00 ± 4.31 mmHg on 1.35 ± 1.08 less medications after PEcK and 3.14 ± 2.83 mmHg on 1.01 ± 0.94 less medications after ICE2 (p < 0.001 at POY1 for IOP; p < 0.05 after POW6 for medications).
CONCLUSION
Both PEcK and ICE2 reduce medication and IOP from baseline, with PEcK having more favorable GIC and PRC success rates and greater IOP and medication reduction at 1 year.
目的
比较超声乳化白内障吸除术联合双刀片前房角切开术（PEcK）或两个小梁支架植入术（ICE2）与睫状体光凝术的疗效。
设置
来自三级分诊中心的回顾性、非随机对照研究。
方法
回顾2018年至2022年期间接受PEcK或ICE2治疗的170份病历及总共1294次就诊记录。128例患者接受了PEcK，42例接受了ICE2。排除随访时间少于30天的患者。平均随访时间为505±308天。两条Kaplan-Meier曲线（KM）评估在维持（1）[GIC - 目标眼压标准]眼压≤目标眼压或（2）[PRC - 降低百分比标准]眼压降低≥20%且5 mmHg≤眼压≤21 mmHg至少连续两次就诊的情况下，使用≤基线药物时的生存率。使用配对t检验比较眼压和药物负担的降低情况。
结果
大多数患者为白种人（65%），患有轻度青光眼（43%）。最常见的青光眼类型是原发性开角型青光眼（58%）。手术时的平均年龄为72.2岁。PEcK组术前平均眼压为17.58±4.98 mmHg，使用3.00±1.41种药物；ICE2组术前平均眼压为15.36±3.58 mmHg，使用1.81±1.11种药物（眼压p = 0.015；药物p < 0.001）。在GIC标准下，PEcK在术后6个月（69%对46%，p < 0.001）和术后1年（63%对36%，p < 0.001）的成功率显著更高。在PRC标准下，PEcK在术后6个月（73%对61%，p = 0.031）和术后1年（67%对50%，p = 0.028）的成功率显著更高。PEcK术后1年平均眼压降低5.00±4.31 mmHg，药物减少1.35±1.08种；ICE2术后1年平均眼压降低3.14±2.83 mmHg，药物减少1.01±0.94种（术后1年眼压p < 0.001；术后6周后药物p < 0.05）。
结论
PEcK和ICE2均能使眼压和药物使用量较基线水平降低，PEcK在GIC和PRC标准下成功率更高，且在1年时眼压和药物减少幅度更大。
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