微导管辅助的小梁切开术治疗原发开角型青光眼的远期疗效

Long-term efficacy of ab externo microcatheter-assisted trabeculotomy for primary open-angle glaucoma

目的评估微导管辅助小梁切开术治疗原发开角型青光眼的远期效果和安全性。设计回顾性病例系列。研究对象2015年10月至2018年5月北京同仁眼科中心接受微导管辅助小梁切开术治疗的原发开角型青光眼患者47例(63眼)。方法所有患者均接受微导管辅助的小梁切开术,术后1、3、6个月,1、2、3、4、5年进行随访。以术后不使用降眼压药物,且眼压≤21 mmHg为完全成功,术后需要使用降眼压药物控制眼压≤21 mmHg为条件成功。分析术前与末次随访眼压情况与药物使用情况。根据患者进行小梁切开术前是否有青光眼手术史将患者分为两组,比较两组小梁切开术后的眼压和降眼压药物使用情况。主要指标眼压、抗青光眼药物使用数量、术中及术后并发症,手术成功率。结果术前平均眼压为(24.8±9.0)mmHg,术后末次复查的平均眼压为(16.9±4.7)mmHg(P=0.000)。术前用药(2.9±0.9)种,术后用药(0.7±1.0)种(P=0.000)。术后1、3、5年累积完全成功率分别为72.1%、62.7%、41.2%、,累积条件成功率分别为91.8%、88.1%、76.5%。术后早期所有患者均有不同程度的前房积血,部分患者出现一过性眼压波动。无严重远期并发症出现。末次随访时,术前有无抗青光眼手术史患者的眼压分别为(18.1±5.1)mmHg和(15.7±4.0)mmHg,与术前比两组之间无显著差异(P=0.098)。结论微导管引导的小梁切开术对原发开角型青光眼是一种长期安全有效的降眼压手术方式。术前有无抗青光眼手术史对手术的降眼压效果无显著影响。

Objective To evaluate the long-term efficacy and safety of ab externo microcatheter-assisted trabeculotomy(MAT)for primary open-angle glaucoma(POAG).Design Retrospective case series.Participants Consecutive 47 patients(63 eyes)with POAG who underwent ab externo MAT from October 2015 to May 2018 by a single surgeon in Beijing Tongren Eye Center.Methods Patients were followed before and 1,3,6 months,1,2,3,4,5 years after surgery.Intraocular pressure(IOP)and usage of anti-glaucoma medication were compared between before surgery and last visit after surgery.Surgical success was defined as a postoperative IOP of≤21 mmHg with(qualified success)of without(complete success)the use of anti-glaucoma medication.According to anti-glaucoma surgery history the patients were divided into two groups and compared IOP and usage of medication between two groups.Main Outcome Measures IOP,number of anti-glaucoma drops,surgery successful rate,and the complications.Results The pre-operative IOP was(24.8±9.0)mmHg,and post-operative IOP was(16.9±4.7)(P=0.000).And the pre-operative number of anti-glaucoma drops was(2.9±0.9),post-operative was(0.7±1.0)(P=0.000).The 1-,3-,and 5-year cumulative rate of complete success was 72.1%,62.7%and 41.2%,and those of qualified success was 91.8%,88.1%and 76.5%,respectively.Hyphema was seen in all eyes and part of patients had transient IOP fluctuation in early postoperative days.There were no severe complications occurred in long-term follow-up.The last follow-up IOP with and without anti-glaucoma surgery history was repectively(18.1±5.1)mmHg and(15.7±4.0)mmHg(P=0.098).Anti-glaucoma surgery history did not affect the surgery results.Conclusion Ab externo MAT has long-term effectiveness and safety for POAG.Previous anti-glaucoma surgery does not affect the results of MAT surgery.