Efficacy of KDB ab-interno trabeculectomy for glaucoma
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摘要:
目的 探索双刀刃小梁网切除器(KDB)内路小梁切除术在青光眼中的安全性和有效性，为青光眼治疗方式的选择提供参考。 方法 选取2019年12月—2021年8月在温州医科大学附属眼视光医院行KDB内路小梁切除术的28例患者，按照青光眼类型分为开角型青光眼(OAG)患者(OAG组，22例，23眼)和闭角型青光眼(ACG)白内障超声乳化吸除联合房角分离术(Phaco-GSL)术后患者(ACG组，6例，7眼)。比较2组的眼压、视力、使用降眼压药物种类、并发症、术后视野改变和房角黏连、成功率(完全、条件成功率，严格完全、条件成功率)。 结果 OAG组术后视力(0.28±0.05)优于ACG组(0.61±0.12)，差异有统计学意义(F=9.358，P < 0.05)；OAG组较基线眼压下降≥20%的患眼百分比、眼压≤18 mmHg(1 mmHg=0.133 kPa)患眼百分比、未使用降眼压药物患眼百分比明显高于ACG组，差异均有统计学意义(P < 0.05)；总体青光眼组平均视野缺损(MD)和视野缺损指数(VFI)较基线明显降低(P＜0.05)。2组并发症发生率比较差异均无统计学意义(P＞0.05)。 结论 KDB内路小梁切除治疗青光眼可有效降低眼压，减少降压药使用种类，改善视野缺损。 Abstract:Objective To explore the safety and efficacy of internal trabeculectomy with double-blade trabeculectomy net (KDB) in glaucoma, and to provide a reference for the selection of glaucoma treatment methods. Methods From December 2019 to August 2021, 28 patients who underwent KDB internal trabeculectomy at the Eye Hospital of Wenzhou Medical University were divided into 22 patients with open-angle glaucoma (OAG) according to the types of glaucoma (OAG group). There were two groups: 23 eyes and 6 patients after phacoemulsification and cataract extraction combined with anterior chamber angle separation (Phaco-GSL) for angle-closure glaucoma (ACG group, 7 eyes). Compare the intraocular pressure, visual acuity, types of intraocular pressure-lowering drugs used, complications, postoperative visual field changes and anterior chamber angle adhesions, and success rates (complete, conditional success rate, strictly complete, strict conditional success rate) between the two groups. Results The postoperative visual acuity in the OAG group (0.28±0.05) was superior to 0.61±0.12 that in the ACG group (F=9.358, P < 0.05). The percentage of affected eyes with intraocular pressure drop ≥20% from baseline, percentage of affected eyes with intraocular pressure≤18 mmHg (1 mmHg=0.133 kPa), and percentage of affected eyes without using antiglaucoma drugs were significantly higher in the OAG group than those in the ACG group (P < 0.05). The mean deviation (MD) and visual field index (VFI) were significantly reduced compared to baseline values, with statistical differences (P < 0.05). No statistical differences were exhibited in the incidence rates of four kinds of complications between groups (P>0.05). Conclusion KDB ab-interno trabeculectomy for glaucoma can effectively reduce intraocular pressure, reduce the types of antiglaucoma drugs, and improve the visual field defects. -
表 1 2组青光眼患者一般资料比较
Table 1. Comparison of general data of glaucoma patients in two groups
组别 患眼数 年龄(x±s, 岁) 性别(男性/女性，例) 侧别(左眼/右眼，例) 随访时间(x±s, 月) OAG组 23 56.00(48.00, 68.00) 18/4 12/11 12.00(6.00, 17.00) ACG组 7 62.00(13.00, 62.00) 4/2 2/5 16.00(7.00，20.00) Z值 -0.811 -0.566 P值 0.441 0.581a 0.399a 0.598 注：a为采用Fisher精确检验。 
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表 2 2组青光眼患者手术前后患眼视力、眼压、用药种类比较(x±s)
Table 2. Comparison of visual acuity, intraocular pressure and types of medication of the affected eyes before and after surgery in the two groups of glaucoma patients(x±s)
组别 患眼数 术前视力(logMAR) 术后视力(logMAR) 术前眼压(mmHg) 术后眼压(mmHg) 眼压下降值(mmHg) 术前用药种类(种) 术后用药种类(种) 减少用药种类(种) OAG组 23 0.36±0.07 0.28±0.05b 23.97±5.33 18.02±5.44b 5.95±1.23 3.48±0.51 0.96±0.21b 2.52±0.54 ACG组 7 0.32±0.08 0.61±0.12b 23.57±7.21 17.61±3.66b 5.96±1.23 3.00±0.82 1.57±0.36b 1.43±0.31 统计量 1.156a 9.358c 0.152a 0.158c 0.021a 1.653a 5.281c 6.352a P值 0.192 <0.001 0.729 0.761 0.852 0.062 <0.001 <0.001 注：a为t值，c为F值。与同组术前比较，bP < 0.05。
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表 3 2组青光眼患者各时间点随访患眼数(眼)
Table 3. The number of affected eyes followed up at each time point for the two groups of glaucoma patients (eyes)
组别 随访1个月 随访3个月 随访6个月 随访9个月 随访12个月 末次随访 OAG组 23 21 12 8 11 23 ACG组 7 6 5 2 2 7 合计 30 27 17 10 13 30
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表 4 2组青光眼患者患眼不同时间点眼压及降压药物使用情况比较[患眼数(%)]
Table 4. Comparison of intraocular pressure and antihypertensive drug use at different time points in the affected eyes of glaucoma patients in the two groups [Number of affected eyes (%)]
组别 患眼数 较基线眼压下降≥20%患眼数 Waldχ2 P值 随访1个月 随访3个月 随访6个月 随访9个月 随访12个月 末次随访 OAG组 23 16(69.6) 14(66.7) 9(75.0) 4(50.0) 7(63.6) 17(73.9) 7.828 0.015 ACG组 7 5(71.4) 4(66.7) 4(80.0) 1(50.0) 1(50.0) 4(57.1) 组别 患眼数 眼压≤21 mmHg患眼数 Waldχ2 P值 随访1个月 随访3个月 随访6个月 随访9个月 随访12个月 末次随访 OAG组 23 15(65.2) 19(90.5) 10(83.3) 8(100.0) 11(100.0) 20(87.0) 0.523 0.681 ACG组 7 7(100.0) 4(66.7) 5(100.0) 1(50.0) 1(50.0) 6(85.7) 组别 患眼数 眼压≤18 mmHg患眼数 Waldχ2 P值 随访1个月 随访3个月 随访6个月 随访9个月 随访12个月 末次随访 OAG组 23 14(60.9) 15(71.4) 8(66.7) 6(75.0) 10(90.9) 17(73.9) 7.631 0.016 ACG组 7 5(71.4) 3(50.0) 3(60.0) 1(50.0) 0(0.0) 5(71.4) 组别 患眼数 较基线降眼压药物减少1种以上患眼数 Waldχ2 P值 随访1个月 随访3个月 随访6个月 随访9个月 随访12个月 末次随访 OAG组 23 21(91.3) 19(90.5) 11(91.7) 8(100.0) 11(100.0) 22(95.7) 1.583 0.538 ACG组 7 6(85.7) 4(66.7) 3(60.0) 1(50.0) 1(50.0) 5(71.4) 组别 患眼数 未使用降眼压药物患眼数 Waldχ2 P值 随访1个月 随访3个月 随访6个月 随访9个月 随访12个月 末次随访 OAG组 23 15(65.2) 12(57.4) 5(41.7) 4(50.0) 8(72.7) 11(47.8) 5.706 0.032 ACG组 7 3(42.9) 3(50.0) 2(40.0) 1(50.0) 0(0.0) 1(14.3)
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表 5 2组青光眼患者患眼手术成功率比较(%)
Table 5. Comparison of surgical success rates of the affected eyes between the two groups of glaucoma patients (%)
组别 患眼数 完全成功率 条件成功率 严格完全成功率 严格条件成功率 OAG组 23 47.8(11/23) 91.3(21/23) 39.1(9/23) 73.9(17/23) ACG组 7 14.3(1/7) 85.7(6/7) 14.3(1/7) 71.4(5/7) P值 0.193 0.999 0.372 0.999 注：采用Fisher精确检验。
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表 6 2组青光眼患者患眼术后并发症发生率比较(%)
Table 6. Comparison of the incidence of postoperative complications in the affected eyes of the two groups of glaucoma patients (%)
组别 患眼数 前房积血 睫状体脱离 一过性眼压升高 局部PAS OAG组 23 34.8(8/23) 8.7(2/23) 47.8(11/23) 52.2(12/23) ACG组 7 0 14.3(1/7) 42.9(3/7) 28.6(2/7) P值 0.143 0.999 0.999 0.399 注：采用Fisher精确检验。
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