关键词: 闭角型青光眼, 小梁切除术, 周边虹膜切除术

Abstract: Objective To compare the efficacy and safety of surgical peripheral iridectomy and trabeculectomy for young patients with chronic primary angle-closure glaucoma (CPACG). Design Retrospective comparative case series. Participants Consecutive cases of intermediate and advanced-staged CPACG, aged 40 years or younger, who underwent either trabeculectomy (Trab) or surgical peripheral iridectomy (SPI) as an initial treatment at Zhongshan Ophthalmic Center between January 2012 and December 2022 were enrolled, including 48 patients (67 eyes). Methods The patients were divided into two groups: the Trab group and the SPI group. There were 15 cases (22 eyes) in Trab group and 33 cases (45 eyes) in SPI group. The results of ocular examinations were recorded, including visual acuity, intraocular pressure (IOP), slit-lamp microscopy, fundus examination, gonioscopy, A-scan ultrasonography, ultrasound biomicroscopy, spectral domain optical coherence tomography, and visual field test. Ocular parameters before and after the operation, success rate and incidence of complication were compared between groups. Main Outcome Measures Best corrected visual acuity (BCVA), IOP, anterior chamber depth (ACD), the number of glaucoma medications, the angle opening distance 500 μm from the scleral spur (AOD500), anterior chamber angle (ACA) and surgical success rate. Results A total of 48 PACG patients (67 eyes) were enrolled, including 10 males and 38 females. The median age was 32.0 (24.3-36.0) years old. The mean duration of follow up for Trab group and SPI group was 19.6±22.2 months and 39.1±20.9  months, respectively. The success rate of Trab group was 45.5% (10/22)．The success rate of SPI group was 80.0% (36/45), which was higher than that of Trab group (χ2=15.528, P<0.001). No difference was found in BCVA, IOP, ACD and the number of glaucoma medications between Trab group and SPI group before surgery, and AOD500 and ACA were wider in SPI group (Z=-2.174, P=0.030; and Z=-2.107, P=0.035). At the last visit, BCVA was better (Z=-2.310, P=0.021), ACD was deeper (Z=-4.615, P<0.001), AOD500 and ACA was wider (both Z=-3.924, P<0.001), the IOP was higher (Z=-2.455, P=0.014) and the number of glaucoma medications was more (Z=-5.721, P<0.001) in SPI group than that in Trab group. The postoperative complications in Trab group consisted of shallow anterior chamber (11 eyes) and malignant glaucoma (2 eyes), with an incidence of 59.1% (13/22). While in SPI group, the rate of postoperative complications was 6.7% (3/45 cases of wound leakage), which was much lower than that of Trab group (P<0.001). Conclusion The success rate is lower for trabeculectomy with more complications in young CPACG patients, while the success rate is higher for SPI plus antiglaucoma medications with fewer complications. SPI is more effective and safer than Trab as an initial treatment for young patients with intermediate and advanced-staged CPACG. (Ophthalmol CHN, 2024, 33: 261-266)

Key words: angle-closure glaucoma, trabeculectomy, peripheral iridectomy