目的观察微导管辅助全周小梁切开术治疗玻璃体切割术(PPV)后继发性青光眼的有效性及安全性。
方法采用系列病例观察研究方法，纳入2016年5月至2022年2月在河南省立眼科医院和北京同仁医院接受PPV且术后继发青光眼患者17例17眼，其中接受PPV的原发病包括视网膜脱离13眼，玻璃体积血3眼，眼内炎1眼。所有患者均行激光微导管辅助全周小梁切开术，包括房角镜下内路小梁切开术6眼、经巩膜瓣途径微导管引导下外路小梁切开术11眼。微导管辅助全周小梁切开范围均≥300°，其中360°者11眼，330°者4眼，300°者2眼。分别于术前、术后1周、1个月、6个月、12个月采用Goldmann眼压计测量眼压；采用标准视力表测定最佳矫正视力(BCVA)并转换为LogMAR视力；记录术后用药数量变化及并发症发生情况。评估的主要结局指标为眼压和手术成功率，次要结局指标为术后用药数量、BCVA变化和并发症。手术成功定义为术后使用或不使用降眼压药物的情况下眼压<21 mmHg(1 mmHg＝0.133 kPa)。
结果患者术前及术后1周、1个月、6个月和12个月平均眼压分别为(34.41±5.11)、(21.88±11.72)、(20.77±7.67)、(19.50±7.01)、(16.32±4.68)mmHg，总体比较差异有统计学意义( F＝20.779， P<0.001)，其中术后各时间点眼压均低于术前，差异均有统计学意义(均 P<0.01)。术后12个月，14眼眼压较术前降低40%以上。术后6、12个月手术成功率均为76.5%。术后降眼压药物使用数量较术前明显减少，差异有统计学意义( Z＝－4.580， P<0.001)。术后6个月，术眼BCVA与术前比较差异无统计学意义( Z＝－1.311， P＝0.190)。术眼术后均未见严重并发症发生。
结论微导管辅助全周小梁切开治疗PPV术后继发青光眼具有较好的疗效和安全性。
ObjectiveTo investigate the efficacy and safety of ab externo or ab interno transluminal trabeculotomy in the treatment of secondary glaucoma following pars plana vitrectomy (PPV).
MethodsAn observational case series method was performed.Seventeen eyes of 17 patients with glaucoma following PPV were enrolled in Henan Eye Hospital and Beijing Tongren Hospital from May 2016 to Feburary 2022.Primary conditions of patients receiving PPV included retinal detachment in 13 eyes, vitreous hemorrhage in 3 eyes, and entophthalmia in 1 eye.All the subjects underwent ab externo (11 eyes) or ab interno (6 eyes) transluminal trabeculotomy.The scope of all cases accepted trabeculotomy was ≥300°(11 cases of 360°, 4 cases of 330° and 2 cases of 300°).Before and at 1 week, 1 month, 6 months and 12 months after surgery, the intraocular pressure (IOP) was evaluated by Goldmann Tonometer and the best corrected visual acuity (BCVA) was measured using a standard visual acuity chart and converted to logrithm of minimal angle of resolution (LogMAR).The number of anti-glaucoma drug applications and surgery-related complications were recorded.The primary outcomes evaluated were IOP and surgical success rate.Secondary outcomes were medication quantity, BCVA (LogMAR) changes, and complications.Surgical success was defined as IOP reduction to <21 mmHg (1 mmHg=0.133 kPa) with or without the use of IOP-lowering medication.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Henan Eye Hospital (No.HNEECKY-2021[41]).Written informed consent was obtained from each subject.
ResultsPreoperative, 1-week, 1-month, 6-month, and 12-month postoperative mean IOP was (34.41±5.11), (21.88±11.72), (20.77±7.67), (19.50±7.01), and (16.32±4.68)mmHg, respectively, with an statistically significant overall difference ( F=20.779, P<0.001).IOP at difference time points after surgery were lower than that before surgery, showing statistically significant differences (all at P<0.01).Compared with before surgery, IOP was reduced more than 40% at 12 months after surgery in 14 eyes.Surgical success rates at 6 and 12 months after surgery were both 76.5%.The number of IOP-lowing drugs decreased significantly after operation ( Z=-4.580, P<0.001).The difference in BCVA between before and 6 months after surgery was not statistically significant ( Z=-1.311, P=0.190).No serious complications were seen in any of the operated eyes postoperatively.
ConclusionsAb externo or ab interno transluminal trabeculotomy is safe and effective in the treatment of secondary glaucoma after PPV.
杨潇远,王怀洲,金鑫,等. 微导管辅助全周小梁切开术对PPV术后继发性青光眼的疗效及安全性评估[J]. 中华实验眼科杂志,2024,42(06)：520-526.
DOI:10.3760/cma.j.cn115989-20230713-00038版权归中华医学会所有。
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杨潇远：设计试验、实施研究、采集数据、分析/解释数据、起草文章、对文章的知识性内容作批评性审阅；王怀洲：酝酿及指导试验、实施研究、采集数据、对文章的知识性内容作批评性审阅及定稿；金鑫：采集数据、起草文章、统计分析；马聪慧：分析/解释数据；崔红培：采集数据、统计分析；刘茜：采集数据、资料分析；李海军：采集数据、材料支持
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