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积血为9%(5/56),IOP Spike为29%(16/56),未发生严重并发症。结论:GATT具有较好的降压效果,可显著减少患者术后用药,且无严重并发症;IOP Spike并未加重视功能损害,GATT对于中晚期POAG仍是一种可选择的有效手术方式。
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-stage group 0(0,3)(Z=-2.00,P=0.045).At 12 months postoperatively,the total success rates were 80.0%for the moderate-stage group and 67.7%for the advanced stage group,respectively.The qualified success rates were 25%and 39%,respectively,with no significant difference observed between the two groups(all P>0.05).However,the complete success rates exhibited a notable contrast,with 55%in the moderate-stage group and 28%in the advanced-stage group,showing a significant difference(χ^(2)=4.07;P=0.044).Comparatively,the total success rates were 69%in the IOP spike group and 72%in the non-IOP spike group,showing no significant difference(P>0.05).However,there were notable difference in complete success rates,with 63%and 50.0%,and qualified success rates,with 62%and 22%,respectively.These differences were statistically significant(χ^(2)=9.33,P=0.002;χ^(2)=8.16,P=0.004).There was no statistically significant difference in BCVA and VF for IOP spike patients,respectively,between preoperatively and 3 months postoperatively(all P>0.05).The incidence of complications presented hyphema 100%,persistent hyphema 9%(5/56),IOP spikes 29%(16/56)without serious consequence.Conclusion:GATT is a viable surgical option for moderate and advanced POAG,which presents notable hypotensive effect and remarkable reduction on medications without serious complications,including no evidently worse visual function after IOP spike.
作者
刘岳峰
黄肖霞
郭亮
熊婵
余学清
张旭
杨璐
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)
出处
《中华眼视光学与视觉科学杂志》
CAS
CSCD
北大核心
2024年第7期481-488,共8页
Chinese Journal Of Optometry Ophthalmology And Visual Science
作者简介
第一作者:刘岳峰,(ORCID:0009-0008-1228-4481),Email:1078088319@qq.com;通信作者:杨璐,(ORCID:0000-0003-1455-9369),Email:yiwang9@163.com
