Zhang Shaoyang, He WenJing, Lu Peng, Xu Fan, Zhong Haibin, Zhong Shan, Jiang Li
Department of Ophthalmology, Guangxi Key Laboratory of Eye Health & Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology &Institute of Ophthalmic Diseases, the People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, No.6 Taoyuan Road, Nanning, 530000, China.
BMC Ophthalmol. 2025 Apr 28;25(1):256. doi: 10.1186/s12886-025-04097-6.
BACKGROUND: To evaluate the efficacy, safety and complication of different procedure sequence combining gonioscopy-assisted transluminal trabeculotomy (GATT) either before or after phacoemulsification for patient with primary open-angle glaucoma (POAG) and cataract. METHOD: This retrospective, clinic control study included 82 patients (82 eyes) with a diagnosis of POAG with cataract. The patients were divided into two groups: Phaco-GATT group underwent phacoemulsification followed by GATT and GATT-Phaco group underwent GATT followed by phacoemulsification. Intraocular pressure (IOP) changes, best-corrected visual acuity (BCVA), visual field Mean Deviation (MD) and antiglaucoma medication (AGM) were analyzed preoperatively and at postoperatively 1d, 1w, 1 m, 3 m, 6 m, and 12 m. Postoperative complications, including hyphema, IOP spikes, and suprachoroidal effusion, were closely reported. RESULT: A total of 40 eyes were subjected to Phaco-GATT group, and 42 eyes were subjected to GATT-Phaco group. For all patients, significant IOP and AGM reduction and BCVA improvement were observed at each follow-up time points compare to preoperation (all P > 0.05). At 12 months, the visual field MD in the GATT-Phaco group was significantly improved than that in the Phaco-GATT group (P < 0.05). GATT-Phaco group appeared to have less AGM than those in Phaco-GATT group from postoperative 1 month to 12 months, though there was no significantly difference (all P > 0.05). At 12 months postoperatively, GATT-Phaco group demonstrated a slightly higher complete success rate of 76.2% and qualified success rates of 90.5% compare to Phaco-GATT (65.0% and 85.0%). Moreover, in the GATT-Phaco group, BCVA was significantly improved and macrohyphema (> 1 mm) was reduced compare to Phaco-GATT group at early stage. Additionally, no statistically significant differences were observed in IOP spike, descemet's membrane detachment, and supraciliary effusion between two groups at each time point. CONCLUSION: This study demonstrates that combined phacoemulsification and GATT is a safe and effective treatment for POAG patients with cataract. Both surgical sequences are effective, however, initiating with GATT may provide more benefits compare phacoemulsification prior.
背景：评估在原发性开角型青光眼（POAG）合并白内障患者中，超声乳化术之前或之后行房角镜辅助小梁切开术（GATT）的不同手术顺序的疗效、安全性及并发症。 方法：这项回顾性临床对照研究纳入了82例诊断为POAG合并白内障的患者（82只眼）。患者被分为两组：超声乳化-GATT组先进行超声乳化术，然后行GATT；GATT-超声乳化组先进行GATT，然后行超声乳化术。分析术前及术后1天、1周、1个月、3个月、6个月和12个月时的眼压（IOP）变化、最佳矫正视力（BCVA）、视野平均偏差（MD）及抗青光眼药物（AGM）使用情况。密切报告术后并发症，包括前房积血、眼压峰值及脉络膜上腔积液。 结果：超声乳化-GATT组共40只眼，GATT-超声乳化组共42只眼。对于所有患者，与术前相比，各随访时间点均观察到眼压和AGM显著降低，BCVA改善（所有P>0.05）。在12个月时，GATT-超声乳化组的视野MD改善程度显著高于超声乳化-GATT组（P<0.05）。从术后1个月至12个月，GATT-超声乳化组的AGM使用量似乎比超声乳化-GATT组少，尽管无显著差异（所有P>0.05）。术后12个月时，GATT-超声乳化组的完全成功率略高，为76.2%，合格成功率为90.5%，而超声乳化-GATT组分别为65.0%和85.0%。此外，在早期，与超声乳化-GATT组相比，GATT-超声乳化组的BCVA显著改善，且大前房积血（>1mm）减少。另外，两组在各时间点的眼压峰值、Descemet膜脱离及睫状体上腔积液方面均未观察到统计学显著差异。 结论：本研究表明，超声乳化术联合GATT是治疗POAG合并白内障患者的一种安全有效的方法。两种手术顺序均有效，然而，先进行GATT可能比先进行超声乳化术带来更多益处。
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