关键词: 小梁消融术, 开角型青光眼/外科学

Abstract: Objective To evaluate the effectiveness and safety of trabectome surgery (trabeculectomy-internal approach ) in patients with open angle glaucoma. Design Prospective non-comparative case series. Participants 12 eyes of 11 patients with primary open angle glaucoma(POAG), 1 eye with congenital glaucoma and 2 eyes of 2 patients with developmental glaucoma were recruited. Methods Trabectome（NeoMedix Corp.） was inserted to the viscoelastic installed anterior chamber through a 1.7 mm keratome near-limbal temperal corneal incision under operating microscope. The instrument electroablated the meshwork and inner wall of Schlemm’s canal for 120 degree under direct view assisted by goniolens. 2 cases had the Trabectome-phacoemulsification surgeries. The postoperative follow-up period ranged from 3 weeks to 12 months. Success was defined as intraocular pressure (IOP) ≤21 mmHg or ≥20% IOP reduction with or without medications and no secondary glaucoma surgery.  Main Outcome Measures IOP, numbers of adjunctive medications and intraoperative and postoperative complications. Results 53.3% patients finished 3 months follow-up and 20.0% further followed up for one year. Preoperative IOP averaged 27.57±9.46 mmHg in these 15 eyes, mean preoperative number of antiglaucoma medications were 2.27±0.88. Mean postoperative IOP was 20.07±7.86 mmHg and decreased by 17.3%. Postoperative medications reduced to 1.15±1.04. Seven (46.7%) cases achieved the criteria of success at the last visit. Intraoperative blood reflux had occurred in all eyes at instrument removal. Postoperative hyphema at 1 day was noted in 10 of the 15 patients (67.7%) with clearing by a mean of 5.4±3.1 days. Vision decrease of 2 lines or more occurred in 3 of these 10 patients and vision returned to preoperative levels in all patients after spontaneous clearing of hyphema. Gonioscopy revealed focal goniosynechiae in the areas ablated through the follow-up period in 4 eyes (26.7%). Conclusions This small sample and short follow-up period study demonstrated that trabectome surgery is an effective and safe surgery to treat open angle glaucoma. (Ophthalmol CHN, 2014, 23: 13-18)

Key words:  trabeculectomy-internal approach, open angle glaucoma/surgery