University Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129, Trieste, Italy.
Int Ophthalmol. 2024 Jul 7;44(1):317. doi: 10.1007/s10792-024-03174-x.
To evaluate and compare the long-term outcomes of canaloplasty and phaco-canaloplasty in the treatment of open angle glaucoma and assess the prognostic factors associated with surgical outcome.
A 48-month retrospective analysis was performed on n = 133 open angle glaucoma eyes treated with canaloplasty and n = 57 open angle glaucoma eyes treated with phaco-canaloplasty by a single surgeon. Surgical success was defined according to six criteria, achieving a target intraocular pressure (IOP) ≤ 21, 18 or 15 mmHg on glaucoma medications (qualified success) or without any further treatment (complete success), including laser therapy or surgery. Kaplan-Meier survival analysis and Cox regression analysis were performed to evaluate surgical success and preoperative factors associated with surgical outcome. Surgical complications in the early postoperative period were compared between canaloplasty and phaco-canaloplasty.
Canaloplasty and phaco-canaloplasty significantly reduced postoperative IOP and number of glaucoma medications (p = 0.001 for both). Phaco-canaloplasty showed higher rates of cumulative surgical success over canaloplasty, but only for target IOP ≤ 21 and ≤ 18 (p = 0.018 and p = 0.011, respectively). A preoperative number of > 4 glaucoma medications predicted surgical failure. Phaco-canaloplasty was associated with a higher rate of IOP peaks in the first month compared with canaloplasty (40.4% vs 12.7%, p = 0.000).
Canaloplasty and phaco-canaloplasty demonstrated long-term efficacy in the treatment of open angle glaucoma, with phaco-canaloplasty showing higher rates of surgical success compared to canaloplasty, but not for target IOPs lower than 16 mmHg. Patients on more than 4 preoperative glaucoma medications may not be good candidates for canaloplasty and may benefit from other surgical options.
评估和比较房水引流管植入术和超声乳化白内障吸除术联合房水引流管植入术治疗开角型青光眼的长期疗效，并探讨与手术效果相关的预测因素。
对单名外科医生治疗的 133 例开角型青光眼行房水引流管植入术和 57 例开角型青光眼行超声乳化白内障吸除术联合房水引流管植入术患者进行了 48 个月的回顾性分析。根据以下 6 项标准来定义手术成功：眼压（IOP）控制目标值为 21mmHg、18mmHg 或 15mmHg，使用降眼压药物（合格成功）或无需任何进一步治疗（完全成功），包括激光治疗或手术。Kaplan-Meier 生存分析和 Cox 回归分析用于评估手术成功率和与手术效果相关的术前因素。比较房水引流管植入术和超声乳化白内障吸除术联合房水引流管植入术在术后早期的手术并发症。
房水引流管植入术和超声乳化白内障吸除术联合房水引流管植入术均能显著降低术后 IOP 和降眼压药物的使用次数（均 p=0.001）。超声乳化白内障吸除术联合房水引流管植入术较房水引流管植入术有更高的累积手术成功率，但仅在眼压控制目标值为 21mmHg 和 18mmHg 时具有统计学意义（分别为 p=0.018 和 p=0.011）。术前使用降眼压药物种类数>4 预测手术失败。与房水引流管植入术相比，超声乳化白内障吸除术联合房水引流管植入术在术后第 1 个月时发生眼压高峰的比例更高（40.4% vs 12.7%，p=0.000）。
房水引流管植入术和超声乳化白内障吸除术联合房水引流管植入术在治疗开角型青光眼方面均具有长期疗效，超声乳化白内障吸除术联合房水引流管植入术的手术成功率高于房水引流管植入术，但对眼压控制目标值低于 16mmHg 的患者并无优势。对于术前使用降眼压药物种类数>4 种的患者，房水引流管植入术可能不是一个很好的选择，他们可能受益于其他手术方案。
