Mori Hidetsugu, Kiriishi Tatsunori, Omi Masatoshi, Ohnaka Masayuki, Imai Hisanori
Department of Ophthalmology, Kansai Medical University, Hirakata 573-1010, Osaka, Japan.
J Clin Med. 2024 Dec 16;13(24):7653. doi: 10.3390/jcm13247653.
Primary open-angle glaucoma (POAG), if caused by elevated intraocular pressure (IOP), may require a trabeculotomy (LOT), in which the trabecular meshwork (TM) and Schlemm's canal (ISC) are incised. However, the association between the incision angle and outcomes remains unclear. Therefore, in this study, we investigated the surgical outcomes of a trabeculotomy combined with cataract surgery in patients with POAG over a 12-month follow-up period. We included 66 patients (corresponding to 83 eyes) with POAG who underwent trabeculotomy ab externo with a metal probe (M-LOT: 120° incision of the TM and ISC), ab interno with a Kahook Dual Blade (K-LOT: 180° incision of the TM and ISC), or ab interno with a 5-0 nylon suture (S-LOT: 360° incision of the TM and ISC) between January 2015 and December 2022. We assessed IOP, the percentage reduction from preoperative IOP, the number of IOP-lowering medications taken, the incidence of postoperative complications, and the success rate using Kaplan-Meier survival analysis. The median IOP was significantly lower than the baseline across all three groups. The number of IOP-lowering medications taken was significantly reduced only in the M-LOT group. The mean percentage reduction from the preoperative IOP in the K-LOT group was significantly lower than that in the M and S-LOT groups. Beween those subjected to an ab ineterno LOT, the S-LOT group demonstrated a significantly higher rate of IOP reduction 12 months after the operation compared to the K-LOT group. Kaplan-Meier cumulative survival analyses revealed a lower success rate for the K-LOT group than for the M and S-LOT groups. The M-LOT group had the lowest incidence of hyphema and IOP spikes, whereas the S-LOT group had the highest incidence of these complications. The M-, K-, and S-LOTs had different surgical outcomes during the 12 months of follow-up, with the M-LOT group showing the fewest complications. These results will help in selecting the most suitable trabeculotomy strategy for patients with POAG. Based on the postoperative outcomes of the ab interno K- and S-LOTs, a wider incision of the TM and ISC leads to effective IOP reduction.
原发性开角型青光眼（POAG），如果是由眼压（IOP）升高引起的，可能需要进行小梁切开术（LOT），即切开小梁网（TM）和施莱姆管（ISC）。然而，切口角度与手术效果之间的关联仍不明确。因此，在本研究中，我们调查了POAG患者小梁切开术联合白内障手术在12个月随访期内的手术效果。我们纳入了66例（对应83只眼）POAG患者，他们在2015年1月至2022年12月期间接受了外路金属探针小梁切开术（M-LOT：TM和ISC 120°切口）、内路Kahook双刃刀小梁切开术（K-LOT：TM和ISC 180°切口）或内路5-0尼龙缝线小梁切开术（S-LOT：TM和ISC 360°切口）。我们评估了眼压、与术前眼压相比的降低百分比、使用的降眼压药物数量、术后并发症发生率以及采用Kaplan-Meier生存分析的成功率。所有三组的眼压中位数均显著低于基线。仅M-LOT组使用的降眼压药物数量显著减少。K-LOT组术前眼压的平均降低百分比显著低于M-LOT组和S-LOT组。在接受内路LOT的患者中，S-LOT组术后12个月的眼压降低率显著高于K-LOT组。Kaplan-Meier累积生存分析显示，K-LOT组的成功率低于M-LOT组和S-LOT组。M-LOT组前房积血和眼压峰值的发生率最低，而S-LOT组这些并发症的发生率最高。在12个月的随访期间，M-LOT、K-LOT和S-LOT的手术效果不同，M-LOT组的并发症最少。这些结果将有助于为POAG患者选择最合适的小梁切开术策略。基于内路K-LOT和S-LOT的术后结果，TM和ISC更宽的切口可有效降低眼压。
