周边虹膜切除联合房角分离及房角切开术治疗中晚期PACG的有效性及安全性评估

Surgical outcome and safety of peripheral iridectomy plus goniosynechialysis and goniotomy in the treatment of advanced primary angle-closure glaucoma

目的评估周边虹膜切除(SPI)联合房角分离(GSL)及房角切开术(GT)治疗中晚期原发性闭角型青光眼(PACG)的有效性及安全性。方法采用前瞻性多中心系列病例观察研究,对2021年8月至2022年1月在中山大学中山眼科中心、邯郸市眼科医院、石家庄市人民医院、四川大学华西医院及重庆医科大学附属第三医院完成SPI+GSL+GT的中晚期PACG患者27例35眼进行至少6个月随访,平均随访9(7,10)个月。采用ETDRS视力表及Goldmann压平眼压计分别测量患者术前和术后最佳矫正视力(BCVA)及眼压。记录患者术前和术后抗青光眼药物使用情况及术后并发症情况。计算手术成功率,手术完全成功定义为不使用任何抗青光眼药物下,眼压控制在5~18 mmHg(1 mmHg=0.133 kPa)且眼压较基线下降20%,无威胁视力的并发症,无需接受额外的抗青光眼手术,无光感丢失;条件成功定义为使用抗青光眼药物的条件下达到完全成功的标准。结果术眼术后6个月平均眼压为(15.69±3.70)mmHg,明显低于术前的(30.83±8.87)mmHg,差异有统计学意义(t=8.588,P<0.001);眼压平均降低13.00(8.00,21.00)mmHg,降幅为44.00%(34.78%,60.00%)。术后使用抗青光眼药物数量为0(0,1)种,较术前的2(0,3)种明显减少,差异有统计学意义(Z=-3.659,P<0.001)。术前、术后6个月BCVA分别为0.80(0.63,1.00)和0.80(0.60,1.00),差异无统计学意义(Z=-0.283,P=0.777)。手术完全成功率为62.86%(22/35),条件成功率为91.43%(32/35)。手术并发症主要包括前房积血(6/35)、一过性眼压升高(3/35)和术后浅前房(4/35),未发生威胁视力的并发症。结论SPI+GSL+GT是治疗中晚期PACG安全、有效的方法,为PACG的治疗提供了新的思路。

Objective To evaluate the preliminary effectiveness and safety of surgical peripheral iridectomy(SPI)combined with goniosynechilysis(GSL)and goniotomy(GT)in the treatment of advanced primary angle-closure glaucoma(PACG).Methods A multicenter observational case series study was performed.Thirty-five eyes of 27 patients with advanced PACG,who underwent SPI+GSL+GT with a follow-up of at least 6 months,were included from August 2021 to January 2022 at Zhongshan Ophthalmic Center,Handan City Eye Hospital,Shijiazhuang People's Hospital,West China Hospital of Sichuan University,and the Third Affiliated Hospital of Chongqing Medical University.The mean follow-up time was 9(7,10)months.Pre-and post-operative best corrected visual acuity(BCVA)and intraocular pressure(IOP)were measured with an ETDRS chart and a Goldmann applanation tonometer,respectively.The number of anti-glaucoma medications applied before and after surgery was recorded,and the complications after surgery were analyzed.Success rate of surgery was calculated.Complete surgical success was defined as an IOP of 5-18 mmHg(1 mmHg=0.133 kPa)and 20%reduction from baseline without anti-glaucoma medication or reoperation.Qualified success was defined as achieving criterion of complete success under anti-glaucoma medications.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Zhongshan Ophthalmic Center,Sun Yat-sen University(No.2021KYPJ177).Written informed consent was obtained from each subject.Results The mean preoperative IOP was(30.83±8.87)mmHg,which was significantly decreased to(15.69±3.70)mmHg at 6 months after the surgery(t=8.588,P<0.001),with a 44.00%(34.78%,60.00%)decline of 13.00(8.00,21.00)mmHg.The median number of anti-glaucoma medications was significantly reduced from 2(0,3)preoperatively to 0(0,1)postoperatively(Z=-3.659,P<0.001).The mean preoperative and postoperative 6-month BCVA were 0.80(0.63,1.00)and 0.80(0.60,1.00),respectively,showing no significant difference(Z=-0.283,P=0.777).Complete surgical success rate was 62.86%(22/35),and the qualified success rate was 91.43%(32/35).Surgical complications mainly included hyphema(6/35),IOP spike(3/35),and shallow anterior chamber(4/35).There was no vision-threatening complication.Conclusions SPI+GSL+GT is preliminarily effective and safe in the treatment of advanced PACG,which provides a new option for PACG.