Mochizuki Tsukasa, Hirooka Kazuyuki, Okada Naoki, Onoe Hiromitsu, Tokumo Kana, Okumichi Hideaki, Kiuchi Yoshiaki
Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, 734-8551, Japan.
Clin Ophthalmol. 2024 Jan 3;18:9-16. doi: 10.2147/OPTH.S446168. eCollection 2024.
The aim of this study was to evaluate ab interno trabeculotomy outcomes without phacoemulsification.
This retrospective study evaluated 118 eyes of patients aged 18 and above who underwent ab interno trabeculotomy between December 2017 and August 2022. When surgeries were performed in both eyes, only the eye undergoing the initial surgery was evaluated. Prior to and after surgery, the intraocular pressure (IOP) and mean number of IOP-lowering medications were compared. An IOP of ≤21 mmHg (A) and ≤18 mmHg (B) along with a ≥20% reduction in the preoperative IOP was defined as survival. Cases that required reoperation for glaucoma were defined as surgical failure. The Kaplan-Meier method was used to evaluate the survival rates. A Cox proportional hazards model was used to analyze the preoperative factors that influenced survival rates.
At 36 months postoperatively, the 13.4 ± 2.8 mmHg average IOP was significantly decreased from the preoperative 23.5 ± 9.8 mmHg value ( < 0.0001). Moreover, a significant decrease in the mean number of the IOP-lowering medications to 2.3 ± 1.4 at 36 months was found versus the initial 3.9 ± 1.1 preoperative value ( < 0.0001). The survival rates for criteria A and B at 36 months postoperatively were 28% and 25%, respectively. Only the preoperative IOP was identified by multivariate analysis as a factor influencing survival rates ( < 0.0001). Hyphema in 36 eyes (30.5%) and an IOP spike in 20 eyes (16.9%) were the only observed complications. Additional glaucoma surgery was required in 27 eyes (22.9%) during the follow-up period.
Utilization of ab interno trabeculotomy effectively lowered the IOP and reduced the number of IOP-lowering medications. Patients with higher preoperative IOP exhibited better postoperative outcomes.
本研究旨在评估非超声乳化的内路小梁切开术的效果。
这项回顾性研究评估了2017年12月至2022年8月期间接受内路小梁切开术的118例18岁及以上患者的眼睛。当双眼都进行手术时，仅评估接受初次手术的眼睛。比较手术前后的眼压（IOP）和降低眼压药物的平均数量。眼压≤21 mmHg（A）和≤18 mmHg（B）以及术前眼压降低≥20%被定义为成功。需要再次进行青光眼手术的病例被定义为手术失败。采用Kaplan-Meier方法评估成功率。使用Cox比例风险模型分析影响成功率的术前因素。
术后36个月时，平均眼压从术前的23.5±9.8 mmHg显著降至13.4±2.8 mmHg（<0.0001）。此外，与术前初始的3.9±1.1相比，36个月时降低眼压药物平均数量显著减少至2.3±1.4（<0.0001）。术后36个月时标准A和标准B的成功率分别为28%和25%。多因素分析仅确定术前眼压是影响成功率的一个因素（<0.0001）。仅观察到36只眼（30.5%）出现前房积血和20只眼（16.9%）出现眼压峰值。随访期间27只眼（22.9%）需要再次进行青光眼手术。
内路小梁切开术的应用有效降低了眼压并减少了降低眼压药物的数量。术前眼压较高的患者术后效果更好。
