结论:手术周围虹膜切除术的组合,性腺分离,房角切开术是治疗无白内障的晚期原发性闭角型青光眼安全有效的手术方法。
目的:评估手术周边虹膜切除术(SPI)的疗效和安全性,性腺分离(GSL),无白内障的晚期原发性闭角型青光眼(PACG)眼的房角切开术(GT)。
方法:对接受联合SPI的患者进行了一项前瞻性多中心观察性研究,GSL,和GT用于无白内障的晚期PACG。在手术前后对患者进行评估。完全成功定义为达到6-18mmHg的眼内压(IOP),与基线相比至少降低20%。不使用降眼药物或再次手术。合格的成功采用相同的标准,但允许使用药物。采用logistic回归分析与手术成功相关的因素。
结果:共纳入50只晚期PACG的61只眼。所有参与者都完成了12个月的随访。36只眼睛(59.0%)取得圆满成功,56只眼(91.8%)取得合格成功。术前和术后12个月平均IOP分别为29.7±7.7和16.1±4.8mmHg,分别。在12个月内,降眼药物的平均数量从1.9减少到0.9。主要并发症包括IOP峰值(n=9),前房积血(n=7),和浅前房(n=3)。回归分析显示年龄较大(比值比[OR]=1.09;P=0.043)与完全成功呈正相关,而混合角度闭合机制(OR=0.17;P=0.036)降低了成功率。
结论:SPI的组合,GSL,GT是一种安全有效的无白内障晚期PACG手术方法。作为这些患者的一线治疗选择,它具有很大的潜力。
CONCLUSIONS: The combination of surgical peripheral iridectomy, goniosynechialysis, and goniotomy is a safe and effective surgical approach for advanced primary angle closure glaucoma without cataract.
OBJECTIVE: To evaluate the efficacy and safety of surgical peripheral iridectomy (SPI), goniosynechialysis (GSL), and goniotomy (GT) in advanced primary angle closure glaucoma (PACG) eyes without cataract.
METHODS: A prospective multicenter observational study was performed for patients who underwent combined SPI, GSL, and GT for advanced PACG without cataract. Patients were assessed before and after the operation. Complete success was defined as achieving intraocular pressure (IOP) between 6 and 18 mm Hg with at least a 20% reduction compared with baseline, without the use of ocular hypotensive medications or reoperation. Qualified success adopted the same criteria but allowed medication use. Factors associated with surgical success were analyzed using logistic regression.
RESULTS: A total of 61 eyes of 50 advanced PACGs were included. All participants completed 12 months of follow-up. Thirty-six eyes (59.0%) achieved complete success, and 56 eyes (91.8%) achieved qualified success. Preoperative and postsurgical at 12 months mean IOPs were 29.7±7.7 and 16.1±4.8 mm Hg, respectively. The average number of ocular hypotensive medications decreased from 1.9 to 0.9 over 12 months. The primary complications included IOP spike (n=9), hyphema (n=7), and shallow anterior chamber (n=3). Regression analysis indicated that older age (odds ratio [OR]=1.09; P =0.043) was positively associated with complete success, while a mixed angle closure mechanism (OR=0.17; P =0.036) reduced success rate.
CONCLUSIONS: The combination of SPI, GSL, and GT is a safe and effective surgical approach for advanced PACG without cataract. It has great potential as a first-line treatment option for these patients.