关键词: 青少年型开角型青光眼, 小梁切开术, 微创青光眼手术, 眼压

Abstract: Objective To systematically compare the long-term postoperative efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) and microcatheter-assisted circumferential trabeculotomy (MAT) and to provide a reference for the treatment of juvenile open-angle glaucoma (JOAG). Design Retrospective case series. Participants From January 2018 to June 2021, a total of JOAG patients who visited the Glaucoma Department of the Second People's Hospital of Zhengzhou and underwent trabeculotomy surgery were included in the study. Among them, there were 22 cases (30 eyes) in the GATT group and 19 cases (24 eyes) in the MAT group. Methods The patients were divided into the GATT group and the MAT group according to the surgical procedure. The preoperative and postoperative (at 1 day, 1 week, 1, 3, 6, 9 months, and 1 year) intraocular pressure (IOP) were recorded, as well as the types of antiglaucoma medications used during the 1-year follow-up. Complete success of the surgery was defined as achieving an IOP between 6~18 mmHg or a reduction in IOP by more than 20% from baseline without the use of antiglaucoma medications. Qualified success was defined as an IOP ＜21 mmHg or a reduction in IOP by more than 20% from baseline, along with a decrease in the use of antiglaucoma medications. Compare the IOP levels, medication use, and surgical success rates at different time points. Main Outcome Measures IOP, medications, success rate. Results The IOP in both groups was significantly lower than before surgery in 1 day, 1 week, 1 month, 3 months, 6 months, 9 months, and 1 year after surgery (all P<0.05). Compared to preoperative levels, the decrease in IOP at 1 day after surgery was greater in the MAT group (21.1±14.8) mmHg compared to the GATT group (13.4±12.2) mmHg (t=-2.105, P=0.040). However, there was no statistically significant difference in the change of IOP between the two groups at the various follow-up time points from 1 week to 1 year after surgery. One year after surgery, the median number of drugs in both the GATT and MAT groups decreased by three, which was significant compared to before surgery (both P<0.001). One year after surgery, the complete success rate was 60.0% in the GATT group and 70.8% in the MAT group, while the qualified success rate was 90.0% in the GATT group and 95.8% in the MAT group, with no significant difference between the two groups. The two groups had no significant difference in the abnormal IOP events. Conclusion For JOAG population, MAT demonstrates a greater reduction in IOP in the early stage, while GATT and MAT have the same long-term IOP lowering effect and success rate, and there is no difference in the abnormal IOP events between both surgeries. (Ophthalmol CHN, 2023, 32: 471-476)

Key words: juvenile open-angle glaucoma, trabeculotomy, minimally invasive glaucoma surgery, intraocular pressure