房角镜辅助的360°小梁切开术治疗中晚期原发性开角型青光眼疗效观察  

Efficacy Observation of Gonioscopy-Assisted Transluminal Trabeculotomy in Patients with Moderate to Advanced Primary Open Angle Glaucoma

作　　者：刘岳峰 黄肖霞 郭亮[1] 熊婵[1] 余学清[1] 张旭[1] 杨璐[1] Yuefeng Liu;Xiaoxia Huang;Liang Guo;Chan Xiong;Xueqing Yu;Xu Zhang;Lu Yang(The Affiliated Eye Hospital of Nanchang University,Jiangxi Branch of National Clinical Research Center for Ocular Diseases,Jiangxi Province Key Laboratory of Ophthalmology and Vision Science,Jiangxi Clinical Research Center for Ophthalmic Disease,Nanchang 330006,China)

机构地区：[1]南昌大学附属眼科医院,国家眼耳鼻喉疾病临床医学研究中心江西分中心,眼科学与视觉科学江西省重点实验室,江西省眼科疾病临床医学研究中心,南昌330006

出　　处：《中华眼视光学与视觉科学杂志》2024年第7期481-488,共8页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的:评价房角镜辅助的360°小梁切开术(GATT)治疗中晚期原发性开角型青光眼(POAG)患者的临床疗效和安全性。方法:回顾性研究。连续纳入2020年4月至2022年1月在南昌大学附属眼科医院成功施行360°GATT且完成12个月按时随访的中晚期POAG患者48例(56眼),根据国际视野分期法分为中期组19例(20眼)和晚期组31例(36眼),根据术后是否出现一过性高眼压(IOP Spike)分为IOP Spike组(40眼)和非IOP Spike组(16眼)。比较中、晚期组术前及术后1、3、6、12个月的眼压、用药种类、术后并发症情况(前房出血、IOP Spike)以及手术成功率(总成功率、完全成功率和条件成功率);比较IOP Spike组术前与术后3个月的最佳矫正视力(BCVA)和视野(VF)。数据分析采用t检验、非参数秩和检验、卡方检验及Log-Rank两两检验统计方法。结果:术后12个月时,所有患者眼压由术前的(27.0±7.6)mmHg(1 mmHg=0.133 kPa)降为(14.5±2.0)mmHg,用药种类由术前的3(3,4)种降为2(0,4)种,二者均较术前有显著下降(t=11.89,P<0.001;Z=-4.21,P<0.001)。中期组和晚期组的眼压在术后任意随访时间点比较差异均无统计学意义(均P>0.05)。2组平均用药种类在术后1、3、6个月比较差异无统计学意义(均P>0.05);术后12个月时,晚期组用药种类3(0,4)种高于中期组的0(0,3)种,差异有统计学意义(Z=-2.00,P=0.045)。术后12个月,中期组和晚期组总成功率分别为80%、68%,条件成功率分别为25%、39%,差异均无统计学意义(均P>0.05);2组完全成功率分别为55%、28%,差异有统计学意义(χ^(2)=4.07;P=0.044)。IOP Spike组和非IOP Spike组总成功率分别为69%、72%,差异无统计学意义(P>0.05);2组完全成功率分别为63%、50%,条件成功率分别为62%、22%,差异均有统计学意义(χ^(2)=9.33,P=0.002;χ^(2)=8.16,P=0.004)。IOP Spike组术前与术后3个月BCVA、VF比较差异无统计学意义(均P>0.05)。术后前房出血发生率为100%,其中发生持续性前房Objective:To evaluate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy(GATT)in eyes with moderate to advanced primary open angle glaucoma(POAG).Methods:A retrospective study was conducted,involving 48 patients(56 eyes)diagnosed with moderate to advanced POAG who successfully underwent GATT and completed a 12-month follow-up at the Affiliated Eye Hospital of Nanchang University from April 2020 to January 2022.The patients were divided into moderate-stage group(20 eyes)and advanced-stage group(36 eyes)based on the H-P-A Visual Fields Grading System.According to the occurrence of intraocular pressure spike(IOP spike),the patients were divided into an IOP Spike group(40 eyes)and a non-IOP Spike group(16 eyes).The study compared preoperative and postoperative intraocular pressure(IOP),types of medications,postoperative complications(including hyphema and IOP spike),as well as surgical success rates(total success rate,complete success rate,and qualified success rate)at 1,3,6,and 12 months postoperatively,respectively.In the IOP spike group,comparisons of best-corrected visual acuity(BCVA)and visual field(VF)were made between preoperative and 3-month postoperative stage.Statistical analyses were conducted using t-tests,non-parametric rank sum tests,chi-square tests,and pairwise Log-Rank tests.Results:The mean IOP of all participants was decreased from(27.0±7.6)mmHg(1 mmHg=0.133 kPa)preoperatively to(14.5±2.0)mmHg at 12 months postoperatively(t=11.89,P<0.001).The average number of medications was also decreased from 3(3,4)to 2(0,4),and the differences were statistically significant(Z=-4.21,P<0.001).There was no statistically significant difference of IOP between the moderate and advanced-stage groups at any of the postoperative follow-up stage(all P>0.05),as well as the average number of medications at 1,3,and 6 months postoperatively(all P>0.05).But not for at 12 months postoperatively,the advanced-stage group exhibited a higher average number of medications 3(0,4)compared to the moderate-stag

关 键 词：原发性开角型青光眼 房角镜辅助的360°小梁切开术 并发症 微创青光眼手术 

分 类 号：R779.6[医药卫生—眼科]