Kaiya Eye Clinic, 20-40 Sukenobu-cho, Chuo-ku, Hamamatsu, 430-0903, Japan.
Jpn J Ophthalmol. 2024 Sep;68(5):562-570. doi: 10.1007/s10384-024-01105-y. Epub 2024 Aug 29.
To compare surgical results between ab-externo microshunt surgery and trabeculectomy, focusing on postoperative corneal astigmatism.
Retrospective study.
Subjects were patients with glaucoma who underwent either standalone ab-externo microshunt surgery or trabeculectomy. Data on ophthalmic examinations obtained preoperatively and 1, 3, and 5 months postoperatively were analyzed. To assess corneal astigmatism, two separate data sets measured by anterior segment optical coherence tomography and autorefractometer were evaluated. Multivariate linear mixed model analyses were conducted to identify factors associated with the astigmatism changes.
Sixty eyes were examined: 13 eyes underwent microshunt surgery, and 47 eyes underwent trabeculectomy. The total corneal astigmatism measurements by anterior segment optical coherence tomography (AS-OCT) were: - 1.15 ± 0.85 D and - 1.17 ± 0.81 D for the microshunt and trabeculectomy groups, respectively, preoperatively. At five months postoperatively they were - 0.92 ± 0.47 D and - 1.61 ± 0.83 D, respectively (P = 0.807 for the microshunt group and P = 0.005 for the trabeculectomy group: Wilcoxon signed-rank test). AS-OCT also indicated similar results for posterior corneal astigmatism. Autorefractometry also found the total corneal astigmatism was significantly changed only in the trabeculectomy group. The linear mixed model analysis revealed that trabeculectomy (P = 0.001), older age (P = 0.004), and longer postoperative period (P = 0.015) were correlated with greater astigmatism changes. The intraocular pressures significantly decreased following both surgical treatments.
Standalone ab-externo microshunt surgery has less effect on corneal astigmatism during a 5 month period than trabeculectomy. Both surgical procedures significantly reduced intraocular pressure.
比较外路微分流术与小梁切除术治疗青光眼的手术效果，重点关注术后角膜散光。
回顾性研究。
本研究纳入了接受外路微分流术或小梁切除术的青光眼患者。分析了术前及术后 1、3 和 5 个月的眼科检查数据。为了评估角膜散光，我们使用眼前节光学相干断层扫描仪和自动屈光仪分别测量了两组数据。采用多变量线性混合模型分析确定与散光变化相关的因素。
共 60 只眼纳入研究：13 只眼接受微分流术，47 只眼接受小梁切除术。术前眼前节光学相干断层扫描仪（AS-OCT）测量的总角膜散光值分别为：微分流组为-1.15±0.85 D，小梁切除术组为-1.17±0.81 D。术后 5 个月时，两组的总角膜散光值分别为-0.92±0.47 D 和-1.61±0.83 D（微分流组 P = 0.807，小梁切除术组 P = 0.005：Wilcoxon 符号秩检验）。AS-OCT 也表明后角膜散光存在类似的结果。自动屈光仪也发现仅在小梁切除术组中总角膜散光有显著变化。线性混合模型分析表明，小梁切除术（P = 0.001）、年龄较大（P = 0.004）和术后时间较长（P = 0.015）与散光变化较大相关。两种手术治疗均显著降低了眼内压。
在 5 个月的时间内，外路微分流术对角膜散光的影响小于小梁切除术。两种手术方法均显著降低了眼内压。
