Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, Delhi, India.
Avantika Eye Care and Glaucoma Services, New Delhi, India.
Indian J Ophthalmol. 2024 Sep 1;72(9):1280-1284. doi: 10.4103/IJO.IJO_1072_24. Epub 2024 Jul 11.
To assess the safety and efficacy of bent ab interno needle goniectomy (BANG) in moderate to severe primary open angle glaucoma (POAG) eyes undergoing phacoemulsification (phaco).
Single-arm, prospective, interventional study.
POAG patients with medically uncontrolled intraocular pressure (IOP), >15 mmHg for moderate and >12 mmHg for severe POAG, with visually significant cataract were recruited. All patients underwent BANG using a 26-gauge needle to excise 30° of the trabecular meshwork, along with phaco. Primary outcome was IOP. Secondary outcomes were success rate, percentage reduction in IOP/antiglaucoma medications (AGMs), and intraoperative complications. Success at 12 months was defined as: criterion A: IOP <15 mmHg for moderate glaucoma or <12 mmHg for severe glaucoma with or without AGMs OR criterion B: reduction in number of AGMs by >1.
Thirty-two eyes of 32 patients underwent BANG + phaco. Mean age of the participants was 62.7 ± 8.4 years and there were 25 males and seven females. At 12 months, a significant decrease was noted in both IOP (from 17.6 ± 3.6 to 12 ± 1.6 mmHg, 31.8%; P < 0.001) and AGMs (from 3.7 ± 0.9 to 2.8 ± 0.8, 24.3%; P < 0.001). Twenty percent or more reduction in IOP was achieved in 62.5% (20/32) of eyes. Overall success (meeting either of the criteria A or B) at 12 months was achieved in 87.5% eyes. Mild postoperative hyphema was noted in 10 (31.2%) eyes, and two eyes (6.2%) required additional filtration surgery at 7 months.
A 30-degree BANG with phaco in patients of POAG appears to be a safe, effective and affordable MIGS for developing countries.
评估在接受超声乳化白内障吸除术（phaco）的中重度原发性开角型青光眼（POAG）眼中，行内路弯针小梁切开术（BANG）的安全性和有效性。
单臂、前瞻性、干预性研究。
招募患有药物控制不佳的眼压（IOP）的 POAG 患者，中重度 POAG 的 IOP > 15mmHg，重度 POAG 的 IOP > 12mmHg，且存在明显的白内障。所有患者均行 BANG，使用 26 号针头切除 30°小梁网。主要结局为 IOP。次要结局为成功率、IOP/抗青光眼药物（AGM）降低百分比和术中并发症。12 个月时的成功定义为：标准 A：中重度青光眼的 IOP<15mmHg，或重度青光眼的 IOP<12mmHg，同时使用或不使用 AGM；标准 B：AGM 的数量减少>1。
32 例患者的 32 只眼接受了 BANG+phaco。参与者的平均年龄为 62.7 ± 8.4 岁，其中男性 25 例，女性 7 例。12 个月时，IOP（从 17.6 ± 3.6mmHg 降至 12 ± 1.6mmHg，降低 31.8%；P<0.001）和 AGM（从 3.7 ± 0.9 降至 2.8 ± 0.8，降低 24.3%；P<0.001）均显著降低。62.5%（20/32）的眼 IOP 降低 20%以上。12 个月时，87.5%的眼达到总体成功（符合标准 A 或 B 中的任意一项）。10 只眼（31.2%）出现轻度术后前房积血，2 只眼（6.2%）在 7 个月时需要额外的滤过性手术。
在 POAG 患者中施行 30°BANG 联合 phaco 似乎是发展中国家一种安全、有效且负担得起的微创青光眼手术。
