Mayeda Maxwell, Scott Anthony T, Young Cara Capitena, SooHoo Jeffrey R, Pantcheva Mina B, Patnaik Jennifer L, Kahook Malik Y, Seibold Leonard K
Department of Ophthalmology, University of Colorado School of Medicine, Denver, CO.
Department of Psychiatry, University of Colorado School of Medicine, Denver, CO.
J Glaucoma. 2025 Jul 10. doi: 10.1097/IJG.0000000000002610.
Combination MIGS procedures are a potentially more efficacious method to decrease mean IOP and glaucoma medication burden; however, our findings question whether the addition of ECP to excisional goniotomy provides significant additional benefit.
Combined microinvasive glaucoma surgery (MIGS) procedures are gaining popularity. While the individual efficacy of excisional goniotomy and endoscopic cyclophotocoagulation (ECP) is well established, data supporting their use in combination is lacking. Our study aims to evaluate the additive benefit of ECP to excisional goniotomy with the Kahook Dual Blade (KDB) in the largest patient cohort evaluated to date.
and Methods: A retrospective chart review was performed of adults seen at a tertiary eye center between May 2015 and August 2019. Patients who received goniotomy alone were compared to those who received standalone goniotomy and ECP (KDB/ECP), while those who received goniotomy and phacoemulsification (KDB/phaco) were compared to those undergoing phacoemulsification, goniotomy and ECP (PEcK).
A total of 723 eyes were included. All four study groups had a decrease in mean IOP at 6, 12, and 24 months (all P<0.05) and a significant decrease in glaucoma medications at 12 months (all P<0.05). When comparing the KDB group to the KDB/ECP group, there were no statistical differences in mean IOP or number of glaucoma medications at any timepoint (P>0.05 for all). When comparing the KDB/phaco group to the PEcK group there were no statistical differences in mean IOP (P>0.05 for all) or glaucoma medications at 12 and 24 months.
Both standalone KDB goniotomy with ECP and the PEcK procedure are efficacious at lowering IOP and glaucoma medication burden. While success rates were not improved, the addition of ECP to KDB goniotomy appears to achieve a more sustained reduction in medication burden compared to goniotomy alone.
联合微创青光眼手术（MIGS）是一种可能更有效的降低平均眼压和青光眼药物负担的方法；然而，我们的研究结果对在切除性房角切开术中加入内镜睫状体光凝术（ECP）是否能带来显著的额外益处提出了疑问。
联合微创青光眼手术（MIGS）正越来越受欢迎。虽然切除性房角切开术和内镜睫状体光凝术（ECP）各自的疗效已得到充分证实，但支持它们联合使用的数据却很缺乏。我们的研究旨在评估在迄今为止评估的最大患者队列中，ECP对使用卡胡克双刃刀（KDB）进行的切除性房角切开术的附加益处。
对2015年5月至2019年8月在一家三级眼科中心就诊的成年人进行回顾性病历审查。将单纯接受房角切开术的患者与接受单纯房角切开术和ECP（KDB/ECP）的患者进行比较，同时将接受房角切开术和超声乳化术（KDB/超声乳化）的患者与接受超声乳化术、房角切开术和ECP（PEcK）的患者进行比较。
共纳入723只眼。所有四个研究组在6个月、12个月和24个月时平均眼压均下降（所有P<0.05），在12个月时青光眼药物使用量显著下降（所有P<0.05）。将KDB组与KDB/ECP组进行比较时，在任何时间点平均眼压或青光眼药物使用量均无统计学差异（所有P>0.05）。将KDB/超声乳化组与PEcK组进行比较时，在12个月和24个月时平均眼压（所有P>0.05）或青光眼药物使用量均无统计学差异。
单独的KDB房角切开术联合ECP以及PEcK手术在降低眼压和青光眼药物负担方面均有效。虽然成功率没有提高，但与单纯房角切开术相比，在KDB房角切开术中加入ECP似乎能使药物负担得到更持续的降低。
