Xie Zhan, Xiao Tianhao, Huang Junlong, Du Mulong, Zhang Ping, Zhu Ying-Ting, Xie Ping, Sun Hong
Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu Province, P.R. China.
Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China.
BMC Ophthalmol. 2025 Apr 22;25(1):234. doi: 10.1186/s12886-025-04051-6.
To evaluate the 5-year outcomes of trabeculo-canalectomy in the treatment of primary angle-closure glaucoma (PACG) among Chinese patients.
A retrospective study was designed, involving 46 PACG patients (50 eyes) treated with trabeculo-canalectomy at the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2018. The patients were followed up at 1 week, 1 month, 3 months, 6 months, 12 months, 1 year, 2 years and 5 years. Surgical success was defined as intraocular pressure (IOP) ≤ 21 mmHg (1 mmHg = 0.133 kPa) under glaucoma medication (qualified success) and without any glaucoma medication (absolute success). Main outcomes were measured according to IOP, number of medication regimens, surgical success rate, complications, and filtering bleb status.
A total of 46 PACG patients (50 eyes) were finally included for statistical analysis, with a mean age of 56.68 ± 6.75 years (range, 41-69 years). The mean preoperative IOP was 30.72 ± 10.26 mmHg with a median number of medication regimens of 2 (range, 0 to 4). Compared to those before the operation, the mean IOP decreased to 12.15 ± 3.11, 14.33 ± 4.10, 15.68 ± 4.24, 16.45 ± 4.14, 16.95 ± 3.51, 17.67 ± 3.15 and 17.04 ± 3.78 mmHg at 1 week, 1 month, 3 months, 6 months, 12 months, 1 year, 2 years and 5 years, respectively. The median (range) numbers of medication regimens were 0 (0 ~ 1), 0 (0 ~ 2), 0 (0 ~ 2), 0 (0 ~ 2), 0 (0 ~ 2), 0 (0 ~ 3), 0 (0 ~ 3), 0 (0 ~ 3) at the eight time points, respectively. The mean postoperative IOP and the number of medication regimens at each time point were significantly lower than those before operation (all P < 0.01). The 5-year total success rate was 89%, and the absolute success rate was 78%. Shallow anterior chamber (10%) and hyphema (12%) were the most common complications early after surgery. At 3 months, anterior segment slit-lamp photography and ultrasound biomicroscopy showed no obvious filtering blebs in 50 eyes (100%). IOP increased transiently in 6 eyes (12%) within 1 month after surgery.
Simple and cost-saving trabeculo-canalectomy provides favorable 5-year outcomes in the treatment of medically uncontrolled PACG, as shown by more effective IOP control, more obvious drug reduction, as well as fewer post-operative interventions compared to trabeculectomy.
评估小梁-睫状体通道切除术治疗中国原发性闭角型青光眼（PACG）患者的5年疗效。
设计一项回顾性研究，纳入2016年1月至2018年12月在南京医科大学第一附属医院接受小梁-睫状体通道切除术治疗的46例PACG患者（50只眼）。对患者进行1周、1个月、3个月、6个月、12个月、1年、2年和5年的随访。手术成功定义为青光眼药物治疗下眼压（IOP）≤21 mmHg（1 mmHg = 0.133 kPa）（合格成功）且无需任何青光眼药物治疗（绝对成功）。主要结局指标根据眼压、药物治疗方案数量、手术成功率、并发症及滤过泡状态进行测量。
最终纳入46例PACG患者（50只眼）进行统计分析，平均年龄56.68±6.75岁（范围41 - 69岁）。术前平均眼压为30.72±10.26 mmHg，药物治疗方案中位数为2（范围0至4）。与术前相比，术后1周、1个月、3个月、6个月、12个月、1年、2年和5年的平均眼压分别降至12.15±3.11、14.33±4.10、15.68±4.24、16.45±4.14、16.95±3.51、17.67±3.15和17.04±3.78 mmHg。八个时间点的药物治疗方案中位数（范围）分别为0（01）、0（02）、0（02）、0（02）、0（02）、0（03）、0（03）、0（03）。各时间点术后平均眼压和药物治疗方案数量均显著低于术前（均P<0.01）。5年总成功率为89%，绝对成功率为78%。浅前房（10%）和前房积血（12%）是术后早期最常见的并发症。术后3个月，50只眼（100%）的前段裂隙灯照相和超声生物显微镜检查显示无明显滤过泡。术后1个月内6只眼（12%）眼压短暂升高。
与小梁切除术相比，简单且成本节约的小梁-睫状体通道切除术在治疗药物控制不佳的PACG方面提供了良好的5年疗效，表现为眼压控制更有效、药物减少更明显以及术后干预更少。
