内路与外路小梁切开术治疗青少年型开角型青光眼的临床对比研究  

Clinical comparative study on the treatment of juvenile open-angle glaucoma with gonioscopy-assisted transluminal trabeculotomy and microcatheter-assisted circumferential trabeculotomy

作　　者：狄浩浩[1] 陈旭豪 张维嘉 高传文[1] 钱立峰[1] 王怀洲 Di Haohao;Chen Xuhao;Zhang Weijia;Gao Chuanwen;Qian Lifeng;Wang Huaizhou(Zhengzhou Second People's Hospital,Zhengzhou Ophthalmic Hospital,Zhengzhou,450000,China;State Key Laboratory of Ophthalmology,Zhongshan Ophthalmic Center,Sun Yat-sen University,Guangzhou,510060,China;Department of Ophthalmology,Peking University Third Hospital,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve,Beijing,100191,China;Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology and Visual Sciences,Beijing,100730,China)

机构地区：[1]郑州市第二人民医院郑州市眼科医院,郑州450000 [2]中山大学中山眼科中心眼科学国家重点实验室,广州510060 [3]北京大学第三医院眼科眼部神经损伤的重建保护与康复北京市重点实验室,北京100191 [4]首都医科大学附属北京同仁医院北京同仁眼科中心眼科学与视觉科学北京市重点实验室,北京100730

出　　处：《眼科》2023年第6期471-476,共6页Ophthalmology in China

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210727)。

摘　　要：目的比较房角镜辅助下的内路小梁切开术(GATT)及外路小梁切开术(MAT)的长期术后效果及安全性,为青少年型开角型青光眼(JOAG)的治疗选择提供参考。设计回顾性病例系列。研究对象2018年1月~2021年6月在郑州市第二人民医院青光眼科就诊并进行小梁切开手术治疗的JOAG患者,其中GATT组22例(30眼),MAT组19例(24眼)。方法根据术式将患者分为GATT组和MAT组,分别记录术前及术后1天、1周,1、3、6、9个月及1年两组患者的眼压和术后1年复查时使用的抗青光眼药物种类,将手术完全成功定义为不使用抗青光眼药物条件下,眼压为6~18 mmHg或眼压下降幅度超过基线眼压的20%;将条件成功定义为眼压<21 mmHg或眼压下降幅度超过基线眼压的20%,且抗青光眼药物减少。比较不同时间点下的眼压水平、用药情况及手术成功率。主要指标眼压、抗青光眼药物种类、手术完全成功率及条件成功率。结果两组患者术后1天、1周、1个月、3个月、6个月、9个月和1年的眼压均较术前降低(P均<0.05)。与术前相比,术后1天MAT组的眼压下降(21.1±14.8)mmHg,较GATT组下降值(13.4±12.2)mmHg更为显著(t=-2.105,P=0.040)。但术后1周~1年的各个随访时间点,两组患者的眼压变化值均无统计学差异。术后1年,GATT组和MAT组的中位减药数量均为3种,均较术前显著下降(P均<0.001)。术后1年,GATT组的完全成功率为60.0%,MAT组为70.8%;GATT组的条件成功率为90.0%,MAT组为95.8%,两组比较差异均无统计学意义。两组术后早期的眼压异常情况也无显著差异。结论针对JOAG人群,MAT在早期具有更强的降眼压效果,GATT和MAT具有相同的长期降眼压效果及成功率,两者术后眼压异常情况无差异。Objective To systematically compare the long-term postoperative efficacy and safety of gonioscopy-assisted transluminal trabeculotomy(GATT)and microcatheter-assisted circumferential trabeculotomy(MAT)and to provide a reference for the treatment of juvenile open-angle glaucoma(JOAG).Design Retrospective case series.Participants From January 2018 to June 2021,a total of JOAG patients who visited the Glaucoma Department of the Second People's Hospital of Zhengzhou and underwent trabeculotomy surgery were included in the study.Among them,there were 22 cases(30 eyes)in the GATT group and 19 cases(24 eyes)in the MAT group.Methods The patients were divided into the GATT group and the MAT group according to the surgical procedure.The preoperative and postoperative(at 1 day,1 week,1,3,6,9 months,and 1 year)intraocular pressure(IOP)were recorded,as well as the types of antiglaucoma medications used during the 1-year follow-up.Complete success of the surgery was defined as achieving an IOP between 6~18 mmHg or a reduction in IOP by more than 20%from baseline without the use of antiglaucoma medications.Qualified success was defined as an IOP<21 mmHg or a reduction in IOP by more than 20%from baseline,along with a decrease in the use of antiglaucoma medications.Compare the IOP levels,medication use,and surgical success rates at different time points.Main Outcome Measures IOP,medications,success rate.Results The IOP in both groups was significantly lower than before surgery in 1 day,1 week,1 month,3 months,6 months,9 months,and 1 year after surgery(all P<0.05).Compared to preoperative levels,the decrease in IOP at 1 day after surgery was greater in the MAT group(21.1±14.8)mmHg compared to the GATT group(13.4±12.2)mmHg(t=-2.105,P=0.040).However,there was no statistically significant difference in the change of IOP between the two groups at the various follow-up time points from 1 week to 1 year after surgery.One year after surgery,the median number of drugs in both the GATT and MAT groups decreased by three,which was signific

关 键 词：青少年型开角型青光眼 小梁切开术 微创青光眼手术 眼压 

分 类 号：R779.6[医药卫生—眼科]