Fakhraie Ghasem, Ansari Shabnam, Tabatabaei Seyed Mehdi, Hamzeh Nikoo, Vahedian Zakieh, Beikmarzehei Alireza
Glaucoma Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Feinberg school of medicine, Northwestern University, Chicago, Illinois, USA.
Eur J Ophthalmol. 2025 Mar;35(2):618-626. doi: 10.1177/11206721241273977. Epub 2024 Aug 7.
To compare modified viscotrabeculotomy (VCO-Tbo) to modified trabeculotomy (Tbo) in late-onset primary congenital, juvenile open-angle, steroid-induced, and pigmentary glaucoma.
Patients were randomly assigned to VCO-Tbo and Tbo groups in this study. Intraocular pressure (IOP), antiglaucoma medications, and success/failure rates were assessed. A linear mixed model was used to compare the change trend at different follow-up times. Survival time was evaluated using the Kaplan-Meier graph and Log-Rank test.
The mean IOP at 1, 3, and 12 months in the VCO-Tbo group was 14.1 ± 3.1, 15.9 ± 3 and 17 ± 3.1 mmHg, respectively. The mean IOP at the same time points in the Tbo group was 15.9 ± 3.3, 17.6 ± 3.5 and 18.4 ± 3.2 mmHg (P = 0.051, 0.058, 0.088, respectively). The VCO-Tbo group had significantly lower IOP after six months (16.5 ± 4.1 mmHg vs. 18.7 ± 3.8 mmHg; p = 0.031) and by the last visit (16.8 ± 2.1 mmHg vs. 18.8 ± 2 mmHg; p = 0.013). The reduction in the number of medications was significant in both groups compared to baseline (P < 0.001), but there was no significant difference between groups (P = 0.450). The complete and qualified success rate was 43.9% and 34.1% in the VCO-Tbo group and 46.8% and 10.6% in the Tbo group at the final follow-up (p = 0.040, and 0.039, respectively).
Both procedures are effective in IOP and medication reduction. The survival time and efficacy of modified trabeculotomy can be augmented by injecting cohesive viscoelastic in the Schlemm's canal.
比较改良粘弹小梁切开术（VCO-Tbo）与改良小梁切开术（Tbo）在迟发性原发性先天性青光眼、青少年开角型青光眼、类固醇性青光眼和色素性青光眼中的效果。
本研究中患者被随机分配至VCO-Tbo组和Tbo组。评估眼压（IOP）、抗青光眼药物使用情况以及成功率/失败率。采用线性混合模型比较不同随访时间的变化趋势。使用Kaplan-Meier图和Log-Rank检验评估生存时间。
VCO-Tbo组1个月、3个月和12个月时的平均眼压分别为14.1±3.1、15.9±3和17±3.1 mmHg。Tbo组在相同时间点的平均眼压分别为15.9±3.3、17.6±3.5和18.4±3.2 mmHg（P值分别为0.051、0.058、0.088）。VCO-Tbo组在6个月后眼压显著更低（16.5±4.1 mmHg对18.7±3.8 mmHg；p = 0.031），在最后一次随访时也更低（16.8±2.1 mmHg对18.8±2 mmHg；p = 0.013）。与基线相比，两组药物使用数量均显著减少（P < 0.001），但两组之间无显著差异（P = 0.450）。在最终随访时，VCO-Tbo组的完全成功率和合格成功率分别为43.9%和34.1%，Tbo组分别为46.8%和10.6%（p值分别为0.040和0.039）。
两种手术在降低眼压和减少药物使用方面均有效。通过在施莱姆管内注入粘性粘弹剂可延长改良小梁切开术的生存时间并提高疗效。
