新型微创内路三联手术治疗开角型青光眼有效性及安全性的初步研究

A preliminary study on the efficacy and safety of a new type of trabeculotome tunnelling trabeculoplasty for open-angle glaucoma

目的比较新型微创内路三联(3T)手术与房角镜辅助的内路小梁切开术(GATT)治疗开角型青光眼的有效性及安全性。方法前瞻性随机对照研究。连续收集2022年1至7月于首都医科大学附属北京同仁医院眼科中心诊断为开角型青光眼患者,采用随机数字表法分为GATT组(行GATT)和3T组(行3T手术)。记录两组患者术后1 d、1周、1个月、3个月的眼压,使用抗青光眼药物种类数量,术后并发症及手术成功率进行比较。正态分布的计量数据采用独立样本t检验,非正态分布的计量数据采用非参数检验,计数资料采用卡方检验。结果本研究共纳入35例(43只眼)患者,男性27例,女性8例;年龄为(43.0±14.3)岁,范围为20~69岁。其中GATT组23只眼,3T组20只眼。术后3个月两组分别失访5只眼。术前不使用抗青光眼药物情况下最高眼压及使用抗青光眼药物种类数量最多情况下眼压、术后3个月眼压GATT组分别为(33.5±9.1)及(22.2±6.1)、(16.0±3.1)mmHg(1 mmHg=0.133 kPa),3T组分别为(35.2±7.8)及(21.5±6.8)、(16.1±2.0)mmHg,两组比较的差异均无统计学意义(P>0.05)。术后3个月抗青光眼药物使用种类减少不少于2种的眼数GATT组为13只眼,3T组为11只眼,两组比较的差异均无统计学意义(P>0.05)。术后3个月手术完全成功率和条件成功率GATT组分别为14/18和16/18,3T组分别为12/15和13/15,两组比较的差异无统计学意义(P>0.05)。术后1 d前房积血、睫状体脱离和浅前房的发生率GATT组分别为91%(21/23)、35%(8/23)和30%(7/23),3T组分别为55%(11/20)、5%(1/20)和0,两组比较的差异均有统计学意义(P<0.05)。结论3T手术治疗开角型青光眼的有效性与GATT相近,但3T手术的术后并发症更少,安全性更高。(本文于2023年2月28日优先出版在中华医学会杂志社优秀科研成果优先出版平台)

Objective To compare the efficacy and safety of trabeculotome tunnelling trabeculoplasty and gonioscopy-assisted transluminal trabeculotomy(GATT)in the treatment of open-angle glaucoma.Methods A prospective randomized controlled study.The patients with open-angle glaucoma diagnosed in the ophthalmology center of Beijing Tongren Hospital affiliated to Capital Medical University from January to July 2022 were collected and divided into GATT group(undergoing GATT)and 3T group(undergoing 3T operation)using a random number table.Intraocular pressure(IOP)was recorded for both groups at 1 day,1 week,1 month,and 3 months after the operation,and the types and quantities of anti-glaucoma drugs used,postoperative complications,and surgical success rate were compared.Normal distribution measurement data were analyzed using independent sample t-tests,non-normal distribution measurement data were analyzed using non-parametric tests,and counting data were analyzed using chi-square tests.Results This study included 35 patients(43 eyes),consisting of 27 males and 8 females,with an average age of(43.0±14.3)years.There were 21 patients(23 eyes)in the GATT group and 19 patients(20 eyes)in the 3T group.The maximum IOP without anti-glaucoma drugs before surgery,the highest IOP with the maximum number of anti-glaucoma drugs,and the IOP at 3 months after surgery in the GATT group were(33.5±9.1),(22.2±6.1),and(16.0±3.1)mmHg(1 mmHg=0.133 kPa),respectively.The corresponding values for the 3T group were(35.2±7.8),(21.5±6.8),and(16.1±2.0)mmHg.After surgery,the IOP in both groups was lower than before surgery,with a statistically significant difference(P<0.05)and no significant difference between the two groups(P>0.05).In the 3 months following surgery,13 eyes in the GATT group and 11 eyes in the 3T group received more than two types of anti-glaucoma drugs,with no significant difference between the two groups(P>0.05).Three months after surgery,the complete and conditional success rates of the GATT group were 14/18 and 16/18,respectively,and those of the 3T group were 12/15 and 13/15,respectively,with no significant difference between the two groups(P>0.05).The incidence of hyphema,ciliary detachment,and shallow anterior chamber 1 day after surgery was 91%(21/23),35%(8/23),and 30%(7/23),respectively,in the GATT group and 55%(11/20),5%(1/20),and 0 in the 3T group,with a statistically significant difference between the two groups(P<0.05).Conclusion 3T and GATT have similar success rates in the treatment of open-angle glaucoma.However,compared with GATT,3T has fewer complications and is considered to be safer.(This article was published ahead of print on the Online-First Publishing Platform for Excellent Scientific Researches of Chinese Medical Association Publishing House on February 28,2023)