【摘要】 目的:探索外路微导管引导360°或120°小梁切开联合虹膜周边切除术对降低眼压(IOP)、减少抗青光眼药物使用以及改善开角型青光眼(OAG)患者安全性和疗效的作用。方法:回顾性分析。纳入2019年10月至2024年3月期间在恩施地区接受该手术的55例开角型青光眼患者。术前及术后1、3、6、12 mo进行随访,记录IOP、最佳矫正视力(BCVA)、抗青光眼药物使用情况和术后并发症。主要观察指标为术前和术后IOP变化及手术成功率(完全成功:IOP≤18 mmHg且无需药物;部分成功:IOP≤18 mmHg但需药物辅助)。结果:术前平均IOP为26.7±4.4 mmHg,术后1、3、6、12 mo均呈持续下降趋势,且各时间点较术前显著降低(均P<0.001)。术后12 mo完全成功率为62%,部分成功率为38%。抗青光眼药物的使用显著减少,多数患者术后12 mo无需药物辅助维持IOP。术前与术后12 mo BCVA无差异(P=0.19)。术后主要并发症为短暂性前房积血(20%),均于1 wk内自发吸收,未见严重并发症。结论:外路微导管引导的360°或120°小梁切开联合虹膜周边切除术可显著降低OAG患者的IOP,减少药物依赖,且具有较高的安全性,是一种有效的治疗选择。更多还原

【Abstract】 AIM:To evaluate the efficacy and safety of ab-externo microcatheter-guided 360° or 120° trabeculotomy combined with peripheral iridectomy in lowering intraocular pressure(IOP),reducing the need for antiglaucoma medications,and improving clinical outcomes in patients with open angle glaucoma(OAG).METHODS:This retrospective study included 55 patients with OAG who underwent the procedure in the Enshi region between October 2019 and March 2024.Follow-up examinations were conducted at 1,3,6,and 12 mo postoperatively to record IOP,best-corrected visual acuity(BCVA),use of anti-glaucoma medications,and postoperative complications.The primary outcome measures were changes in IOP before and after surgery and surgical success rates(complete success:IOP ≤18 mmHg without medication;partial success:IOP≤18 mmHg with medication).RESULTS:The mean preoperative IOP was 26.7±4.4 mmHg.Postoperatively,the IOP showed a continuous decreasing trend at 1,3,6,and 12 mo,with all time points demonstrating a significant reduction compared with baseline(all P<0.001).At 12 mo postoperatively,the complete success rate was 62%,and the partial success rate was 38%.The use of anti-glaucoma medications was significantly reduced,with most patients maintaining target IOP without pharmacological assistance at 12 mo.No significant difference was observed in BCVA between preoperative and 12-month postoperative assessments(P=0.19).The most common postoperative complication was transient hyphema(20%),which resolved spontaneously within 1 wk,and no severe complications were observed.CONCLUSION:Ab-externo microcatheter-guided 360°or 120° trabeculotomy combined with peripheral iridectomy significantly lowers IOP,reduces medication dependence,and demonstrates a high safety profile,making it an effective and reliable surgical option for patients with OAG.更多还原