Wang Leyi, Wang Chen, Wang Pengyun, Dai Chenyang, Kurmi Rachita, Zhang Wenzhe, Wu Jiayin, Guo Hui
Department of Ophthalmology, Qilu Hospital of Shandong University, Wenhua Xi Road 107, Jinan, 250012, Shandong, PR China.
Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250002, PR China.
BMC Ophthalmol. 2024 Dec 20;24(1):533. doi: 10.1186/s12886-024-03798-8.
Trabeculectomy (TRAB) traditionally has been the gold-standard surgical treatment for primary open-angle glaucoma (POAG), while gonioscopy-assisted transluminal trabeculotomy (GATT) is an emerging minimally invasive surgery used for the treatment of various open-angle glaucoma (OAG) types. In this study, we aimed to compare the efficacy and safety between GATT and TRAB for the treatment of POAG.
This cohort study included eyes with POAG that underwent a single GATT (30 eyes) or TRAB (34 eyes). Follow-up was conducted at 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Intraocular pressure (IOP), the numbers of glaucoma medication, visual field mean deviation, peripapillary retinal nerve fiber layer thickness, surgical time, and complications were analyzed. Success criteria were defined as IOP ≤ 21 mmHg and ≥ 20% IOP reduction from baseline. Qualified and complete surgical success rates were also compared.
IOP and antiglaucoma drug use decreased significantly at 12 months postoperatively in the both groups (P < 0.001), with no significant differences between the two groups pre- and postoperatively (P > 0.05). The success rates at 12 months were 70% (95% confidence interval [CI] = 52.6-87.4%) in the GATT group and 76.5% (95% CI = 61.4-91.5%) in the TRAB group (P = 0.559).Visual field loss remained unchanged at 12 months postoperatively compared with preoperative levels in both groups (P > 0.05); however, peripapillary retinal nerve fiber layer thickness decreased significantly at 12 months postoperatively compared with preoperative levels in the GATT group (P < 0.001). The most frequent complications after TRAB and GATT were bleb-related complications and hyphema, respectively.
GATT demonstrated an efficacy comparable to that of TRAB for the treatment of POAG with regards to lowering IOP, reducing medication use, and preserving visual fields. Thus, GATT is a minimally invasive technique that enables an effective and safe decrease in IOP.
小梁切除术（TRAB）传统上一直是原发性开角型青光眼（POAG）的金标准手术治疗方法，而房角镜辅助经腔小梁切开术（GATT）是一种新兴的用于治疗各种开角型青光眼（OAG）类型的微创手术。在本研究中，我们旨在比较GATT和TRAB治疗POAG的疗效和安全性。
这项队列研究纳入了接受单次GATT（30只眼）或TRAB（34只眼）治疗的POAG患者。术后1天、1周以及1、3、6和12个月进行随访。分析眼压（IOP）、青光眼药物使用数量、视野平均偏差、视乳头周围视网膜神经纤维层厚度、手术时间和并发症。成功标准定义为眼压≤21 mmHg且眼压较基线降低≥20%。还比较了合格和完全手术成功率。
两组术后12个月时眼压和抗青光眼药物使用均显著降低（P<0.001），两组术前和术后无显著差异（P>0.05）。GATT组12个月时的成功率为70%（95%置信区间[CI]=52.6-87.4%），TRAB组为76.5%（95%CI=61.4-91.5%）（P=0.559）。两组术后12个月时视野损失与术前水平相比均无变化（P>0.05）；然而，GATT组术后12个月时视乳头周围视网膜神经纤维层厚度与术前水平相比显著降低（P<0.001）。TRAB和GATT术后最常见的并发症分别是与滤过泡相关的并发症和前房积血。
在降低眼压、减少药物使用和保留视野方面，GATT治疗POAG的疗效与TRAB相当。因此，GATT是一种能够有效且安全地降低眼压的微创技术。
