Comparison of Ex‑PRESS implantation versus trabeculectomy combined with phacoemulsification in primary open‑angle glaucoma:a retrospective in vivo confocal microscopy study  

作　　者：Yuqiao Zhang Beiting He Yulin Zhang Jin Zeng Yanlei Chen Yongyi Niu Honghua Yu Yongjie Qin Hongyang Zhang 

机构地区：[1]Department of Ophthalmology,Guangdong Eye Institute,Guangdong Academy of Medical Sciences,Guangdong Provincial People’s Hospital,No.106 Zhongshan Er Road,Guangzhou 510080,China [2]Shantou University Medical College,Shantou,China [3]The Second School of Clinical Medicine,Southern Medical University,Guangzhou,China [4]Department of Ophthalmology,School of Medicine,South China University of Technology,Guangzhou,China

出　　处：《Eye and Vision》2024年第2期1-11,共11页眼视光学杂志（英文）

基　　金：supported by the National Natural Science Foundation of Guangdong Province(Grant No.2018A030313833);supported by the National Natural Science Foundation of Guangdong Province(Grant No.2020A1515010103);supported by the National Natural Science Foundation Incubation Program of Guangdong Provincial People’s Hospital(Grant No.KY01201147 and KY01201146).

摘　　要：Background:To compare the efficacy of Ex-PRESS implantation versus trabeculectomy combined with phacoemulsification.Methods:A retrospective 12-month study on patients with coincident primary open-angle glaucoma(POAG)and cataract.The patients underwent combined phacoemulsification and Ex-PRESS implant(Phaco-ExPRESS,n=35)or phacotrabeculectomy(Phaco-Trab,n=35).The morphological structures of the filtering bleb were examined by slitlamp,anterior segment optical coherence tomography(AS-OCT)and in vivo confocal microscopy(IVCM).Complete success was defined as postoperative intraocular pressure(IOP)<18 mmHg without the use of anti-glaucoma medication.Qualified success was defined as postoperative IOP<18 mmHg with or without anti-glaucoma medications.The data were collected preoperatively and postoperatively at 2 weeks,1 month,3 months,6 months,and 12 months.Results:No significant difference in the variables such as age,IOP and perimetry was found between the groups of Phaco-ExPRESS and Phaco-Trab.At the one-year postoperative visit for filtering blebs,Phaco-ExPRESS increased the mean area of epithelial microcysts significantly from 0.10±0.05 to 0.20±0.09μm^(2)perμm^(2),while Phaco-Trab decreased the mean area significantly from 0.08±0.04 to 0.04±0.06μm^(2)perμm^(2).Notably,the hyperreflective dots detected by IVCM decreased by 84.9%in Phaco-ExPRESS but increased by 36.3%in Phaco-Trab.The hyperreflective dots were further identified as neutrophil-and monocyte-like cells.The number of these cells were negatively correlated with the microcysts area(r=−0.7,P<0.01)but positively associated with the grade of connective tissue(r=0.5,P<0.01).By creating different microstructural changes in the filtering blebs,Phaco-ExPRESS produced a higher complete success rate(84.9%vs.41.2%,P<0.01)and significant decrease in the number of anti-glaucoma medications(P<0.01)when compared with those in Phaco-Trab.However,the qualified success showed no significant difference between the two groups(100.0%vs.91.2%,P=0.24).Conclusions:At

关 键 词：POAG Ex-PRESS PHACOEMULSIFICATION Confocal microscopy 

分 类 号：R779.66[医药卫生—眼科]