Modified penetrating deep sclerectomy versus conventional trabeculectomy for the treatment of glaucoma: A 12-month randomized prospective study.

IF 3 3区 医学 Q1 OPHTHALMOLOGY
Zhike Xu, Lixiang Wang, Xin Wei
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引用次数: 0

Abstract

Purpose: To compare the surgical outcomes and adverse events of modified penetrating deep sclerectomy with conventional trabeculectomy.

Methods: A prospective randomized clinical study that successively recruited patients with moderate and advanced primary open-angle glaucoma (POAG) and primary angle closure glaucoma (PACG) in West China Hospital. The modified penetrating deep sclerectomy creates a small triangular intrascleral lake, which aims to reduce the risk of flap adhesion in conventional trabeculectomy and sudden hypotony associated with the dissection of a larger rectangular deep scleral flap. The primary effectiveness endpoint was the IOP by non-contact tonometer with or without medication use at each follow-up visit. The primary safety endpoint was the incidence of all complications during the study.

Results: A total of 19 patients (21 eyes) were randomized to modified deep sclerectomy and 21 patients (21 eyes) to conventional trabeculectomy. Age, sex ratio, pre-operative intraocular pressure (IOP) and the number of IOP-lowering medications used were comparable between the two groups. At the end of the follow-up period (12 months), IOPs were (15.52 ± 3.28) mmHg and (19.66 ± 4.01) mmHg in the modified deep sclerectomy and conventional trabeculectomy groups, respectively (p = 0.006). Deterioration of the visual field appeared in four eyes (19.0%) and seven eyes (33.3%) in the two groups (p = 0.33). At 12 months, the average areas of the aqueous outflow pathway were (0.67 ± 0.30) and (0.43 ± 0.26) mm2, demonstrating a significant difference (p = 0.016). Using 18 and 15 mmHg as the IOP criteria for surgical success, the modified penetrating deep sclerectomy group showed a higher overall success rate than the conventional trabeculectomy group at 12 months (18 mmHg: 80.95% vs 52.38%, Log Rank p = 0.033; 15 mmHg: 52.38% vs 4.75%, Log Rank p = 0.001). Complication rates were similar between the two groups (23.8% vs 33.3%, p = 0.55), and no sight-threatening complications were reported.

Conclusions: Modified deep sclerectomy shows superior efficacy in IOP control and maintenance of the outflow pathway opening, with comparable rates of adverse events, resulting in a higher overall success rate.

改良穿透性深巩膜切除术与传统小梁切除术治疗青光眼:一项为期12个月的随机前瞻性研究。
目的:比较改良穿透性深巩膜切除术与常规小梁切除术的手术效果和不良事件。方法:采用前瞻性随机临床研究,先后招募华西医院中晚期原发性开角型青光眼(POAG)和原发性闭角型青光眼(PACG)患者。改良的穿透性深巩膜切除术创造了一个小的三角形巩膜内湖,旨在降低传统小梁切除术中皮瓣粘连的风险,以及与较大的矩形深巩膜瓣剥离相关的突然低斜度。主要有效性终点是每次随访时使用或不使用药物的非接触式眼压计的IOP。主要安全终点是研究期间所有并发症的发生率。结果:19例患者(21眼)随机接受改良深巩膜切除术,21例患者(21眼)随机接受常规小梁切除术。两组患者的年龄、性别比例、术前眼压(IOP)和使用的降眼压药物数量具有可比性。随访12个月时,改良深巩膜切除术组IOPs为(15.52±3.28)mmHg,常规小梁切除术组IOPs为(19.66±4.01)mmHg,差异有统计学意义(p = 0.006)。两组患者视野恶化分别为4眼(19.0%)和7眼(33.3%)(p = 0.33)。12个月时,水流出道的平均面积分别为(0.67±0.30)mm2和(0.43±0.26)mm2,差异有统计学意义(p = 0.016)。以18和15 mmHg作为手术成功的IOP标准,改良穿透性深巩膜切除术组在12个月时的总成功率高于常规小梁切除术组(18 mmHg: 80.95% vs 52.38%, Log Rank p = 0.033;15 mmHg: 52.38% vs 4.75%, Log Rank p = 0.001)。两组并发症发生率相似(23.8% vs 33.3%, p = 0.55),无视力威胁并发症发生。结论:改良的深巩膜切除术在控制眼压和维持流出通道开放方面具有优越的疗效,不良事件发生率相当,总体成功率较高。
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来源期刊
Acta Ophthalmologica
Acta Ophthalmologica 医学-眼科学
CiteScore
7.60
自引率
5.90%
发文量
433
审稿时长
6 months
期刊介绍: Acta Ophthalmologica is published on behalf of the Acta Ophthalmologica Scandinavica Foundation and is the official scientific publication of the following societies: The Danish Ophthalmological Society, The Finnish Ophthalmological Society, The Icelandic Ophthalmological Society, The Norwegian Ophthalmological Society and The Swedish Ophthalmological Society, and also the European Association for Vision and Eye Research (EVER). Acta Ophthalmologica publishes clinical and experimental original articles, reviews, editorials, educational photo essays (Diagnosis and Therapy in Ophthalmology), case reports and case series, letters to the editor and doctoral theses.
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