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.
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.
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.
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.
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.
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。
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。
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。
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。
