Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts.
Ophthalmology Department, Wills Eye Hospital, Philadelphia, Pennsylvania.
Ophthalmol Glaucoma. 2024 Sep-Oct;7(5):476-484. doi: 10.1016/j.ogla.2024.04.005. Epub 2024 Apr 16.
Compare outcomes of tube shunt surgery (Tube) and trabeculectomy with mitomycin C (Trab-MMC) in patients with angle-closure glaucoma (ACG).
Retrospective nonrandomized comparative study.
A total of 80 eyes from 80 patients with ACG who underwent either Tube (N = 50) or Trab-MMC (N = 30) between January 2015 and January 2022 at Massachusetts Eye and Ear.
Reviewed and analyzed 390 visits from patient charts.
Kaplan-Meier (KM) success rates, intraocular pressure (IOP), medication burden, best-corrected visual acuity (BCVA), adjusted hazard ratios (HRs), and complications.
Baseline demographics were similar between both groups, except for a higher proportion of patients with pseudophakia and prior incisional ocular surgery in the Tube group. The Trab-MMC procedure had significantly higher KM complete success (CS) rates than the Tube procedure, but similar qualified success (QS) rates. Under QS, the cumulative probability of survival was 87% in the Tube group and 83% in the Trab-MMC group at year 1 (P = 0.77), and 75% in the Tube group and 58% in the Trab-MMC group at year 2 (P = 0.14). Under CS, the cumulative probability of survival was 13% in the Tube group and 59% in the Trab-MMC group at year 1 (P < 0.001), and 11% in the Tube group and 41% in the Trab-MMC group at year 2 (P < 0.001). Both Tube and Trab-MMC procedures resulted in significant patterns of IOP and medication reduction from baseline up to 2 years with mean IOP reduced to 12.6 ± 5.9 mmHg on 2.8 ± 1.4 medications after Tube and 12.1 ± 6.6 mmHg on 2.4 ± 1.7 medications after Trab-MMC. Patients who underwent Trab-MMC required less IOP-lowering medications at every follow-up visit up to year 1, but a similar number at year 2. No significant differences were found in IOP reduction, BCVA, or complication rates between groups.
We demonstrate that Trab-MMC confers similar IOP reduction and QS rates to Tube placement in patients with ACG. Trab-MMC, however, demonstrated greater medication burden reduction up to 1 year, and more favorable CS rates up to 2 years, while still maintaining similar complication rates to Tube.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
比较闭角型青光眼患者中引流管手术（Tube）和丝裂霉素 C 小梁切除术（Trab-MMC）的治疗效果。
回顾性非随机对照研究。
2015 年 1 月至 2022 年 1 月，马萨诸塞州眼耳医院对 80 例闭角型青光眼患者（80 只眼）进行了 Tube（N=50）或 Trab-MMC（N=30）治疗。
对患者病历中的 390 次就诊进行回顾和分析。
Kaplan-Meier（KM）成功率、眼内压（IOP）、药物负担、最佳矫正视力（BCVA）、调整后的风险比（HR）和并发症。
两组患者的基线人口统计学特征相似，但 Tube 组患者中白内障和既往切口眼手术的比例较高。与 Tube 手术相比，Trab-MMC 手术具有更高的 KM 完全成功率（CS），但 QS 成功率相似。在 QS 下，Tube 组和 Trab-MMC 组在第 1 年的累积生存率分别为 87%和 83%（P=0.77），在第 2 年分别为 75%和 58%（P=0.14）。在 CS 下，Tube 组和 Trab-MMC 组在第 1 年的累积生存率分别为 13%和 59%（P<0.001），在第 2 年分别为 11%和 41%（P<0.001）。Tube 和 Trab-MMC 手术均显著降低了 IOP 和药物使用，至 2 年时平均 IOP 分别从基线值降低至 12.6±5.9mmHg（使用 2.8±1.4 种药物）和 12.1±6.6mmHg（使用 2.4±1.7 种药物）。在第 1 年的每次随访中，接受 Trab-MMC 治疗的患者所需的降眼压药物较少，但在第 2 年所需的药物数量相同。两组间 IOP 降低、BCVA 或并发症发生率无显著差异。
我们证明，在闭角型青光眼患者中，Trab-MMC 与 Tube 植入术相比可实现相似的 IOP 降低和 QS 率。然而，与 Tube 相比，Trab-MMC 可在 1 年内显著降低药物负担，在 2 年内可获得更有利的 CS 率，同时仍保持与 Tube 相似的并发症发生率。
作者没有与本文讨论的材料相关的专有或商业利益。
