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在初级开放角度视光眼中,Ab-Externo MicroShunt与Trabeculectomy相比:来自随机多中心研究的两年结果

Joseph F Panarelli¹, Marlene R Moster², Julian Garcia-Feijoo³

¹New York University, New York, New York.

|September 28, 2023

概括

轨道切除术在两年内,在初级开角青光眼 (POAG) 患者的眼内压力 (IOP) 降低方面,表现出了比MicroShunt更大的外科成功. 这两种手术都有效降低了内脏压力和药物需求,而带切除术的成功率更高.

科学领域:

眼科医生眼科眼科
玻璃眼的手术玻璃眼的手术
医疗器械医疗器械

背景情况:

主要开角青光眼 (POAG) 是全球不可逆转失明的主要原因.
有效的POAG管理通常需要进行手术来降低眼内压力 (IOP).
微冲刺和气管切除术是POAG的手术选择,每个都有不同的机制和结果.

研究的目的:

为了比较MicroShunt的有效性和安全性与POAG患者的轨道切除术.
评估手术成功率,内脏压力降低和药物使用情况.
评估两种手术中不良事件和术后干预的发生率.

主要方法:

在美国和欧洲进行了一项前性,随机的多中心试验.
成年患者 (40-85岁) 患有药物控制不充分的POAG被随机分为3:1进行MicroShunt (n=395) 或trabeculectomy (n=132).
这两种手术都用菌素C (MMC) 进行了增强,手术成功被定义为在不增加药物治疗的情况下,白天IOP降低≥20%.

主要成果:

在2年后,trabeculectomy实现了较高的手术成功率 (64.4%),相比MicroShunt (50.6%) (P=0.005).
两组都显示出显著的IOP降低和从基线减少药物使用 (P<0.001).
下垂体在轨道切除术后 (51.1%) 比MicroShunt (30.9%) (P<0.001) 更频繁,而MicroShunt在6.8%的病例中需要重新定位/移植.

结论:

微射线和轨道切除术都有效地减少POAG患者的IOP和药物使用.
在两年后的随访中,带切除术显示出更高的外科成功率.
虽然这两种手术都有相关的风险,但轨道切除术的低血压发病率更高,而MicroShunt的设备相关干预率更高.

关键词:

抗纤维素剂是一种抗纤维素剂.水性排水装置的水性排水装置.最少侵入性的玻璃眼外科手术.视角开放的玻璃眼 (Open-angle glaucoma) 是一种视角开放的玻璃眼.骨切除术 (TRABECULECTOMY) 是一种切除骨的方法.

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