Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Int Ophthalmol. 2024 Oct 4;44(1):401. doi: 10.1007/s10792-024-03322-3.
To investigate the clinical outcomes of canaloplasty performed with the iTrack microcatheter (Nova Eye Medical, Fremont, USA) as a standalone procedure and in combination with phacoemulsification in patients with primary angle-closure glaucoma (PACG).
A single-center, retrospective case series of eyes undergoing canaloplasty via an ab-interno technique with a diagnosis of PACG based on gonioscopy findings (Shaffer grading). Patients were excluded if they had previously undergone a glaucoma procedure other than Laser Peripheral Iridotomy (LPI). Eyes were grouped by glaucoma severity based on mean deviation preoperative values. Outcome measures included intraocular pressure (IOP) and number of glaucoma medications.
Sixty eyes (9 canaloplasty-standalone, pseudophakic, and 51 canaloplasty + phaco) were eligible. The mean baseline IOP was 21.9 ± 7.3 mmHg and number of glaucoma medications was 1.95 ± 1.4. At the latest follow-up (mean 26 ± 9.2 months), they were reduced to 14.6 ± 3.7 mmHg (p < 0.001) and 0.96 ± 1.2 (p < 0.001). IOP reduction was statistically significant when canaloplasty was performed as a standalone procedure (baseline 22.78 ± 6.72 vs 17.00 ± 3.42 at the latest follow-up) or combined with phacoemulsification (21.75 ± 7.43 vs 14.21 ± 3.66) or if canaloplasty was performed in mild (20.8 ± 4.93 vs 15.5 ± 3.63), moderate (21.9 ± 8.58 vs 13.9 ± 3.90) or severe (23.5 ± 11.3 vs 12.4 ± 3.20) glaucoma eyes, with no difference between the groups postoperatively. Medication reduction was significant when canaloplasty was performed in combination with phacoemulsification and in mild glaucoma eyes. No serious intraoperative or postoperative complications were reported.
Canaloplasty via an ab-interno surgical technique, performed as standalone or combined with phacoemulsification, is a safe and clinically effective treatment in primary angle closure glaucoma patients up to 2 years.
研究经巩膜睫状体平坦部通路微导管（美国 Nova Eye Medical，弗里蒙特）施行内路黏小管成形术（iTrack）作为独立术式和与超声乳化白内障吸除术联合应用于原发性闭角型青光眼（PACG）患者的临床效果。
单中心回顾性病例系列研究，纳入经房角镜检查（Shaffer 分级）诊断为 PACG 且接受经巩膜睫状体平坦部通路微导管施行内路黏小管成形术的患者。排除既往接受过除激光周边虹膜切开术（LPI）以外的青光眼手术的患者。根据术前平均视敏度缺损值将患者分为不同严重程度的青光眼组。观察指标包括眼内压（IOP）和青光眼药物使用数量。
60 只眼（9 只眼为黏小管成形术独立术式、白内障术后和 51 只眼黏小管成形术联合超声乳化白内障吸除术）符合入选标准。基线时的平均 IOP 为 21.9 ± 7.3mmHg，青光眼药物使用数量为 1.95 ± 1.4 种。末次随访（平均 26 ± 9.2 个月）时，IOP 降低至 14.6 ± 3.7mmHg（p<0.001），青光眼药物使用数量降低至 0.96 ± 1.2（p<0.001）。当黏小管成形术作为独立术式（基线时 22.78 ± 6.72mmHg，末次随访时 17.00 ± 3.42mmHg）或与超声乳化白内障吸除术联合施行（基线时 21.75 ± 7.43mmHg，末次随访时 14.21 ± 3.66mmHg）时，IOP 降低具有统计学意义，或者当黏小管成形术应用于轻度（20.8 ± 4.93mmHg，15.5 ± 3.63mmHg）、中度（21.9 ± 8.58mmHg，13.9 ± 3.90mmHg）或重度（23.5 ± 11.3mmHg，12.4 ± 3.20mmHg）青光眼患者时，IOP 降低也具有统计学意义，术后各组间无差异。当黏小管成形术与超声乳化白内障吸除术联合施行或应用于轻度青光眼患者时，药物使用数量降低具有统计学意义。术中及术后均未发生严重并发症。
经巩膜睫状体平坦部通路微导管施行内路黏小管成形术作为独立术式或与超声乳化白内障吸除术联合施行，是原发性闭角型青光眼患者的一种安全且具有临床疗效的治疗方法，2 年随访结果良好。
