Table 1_Comparison of efficacy and safety of combined phacoemulsification, goniosynechialysis and goniotomy with trabeculectomy in advanced primary angle-closure glaucoma: a retrospective observational study.docx

PurposeThe study is a retrospective observational study. This study aimed to compare the intraocular pressure (IOP) lowering effect of phacoemulsification combined with intraocular lens implantation (PEI), Goniosynechialysis (GSL), and goniotomy (GT) vs. trabeculectomy (TRAB) in eyes with medically uncontrolled advanced primary angle-closure glaucoma (PACG) at a 12-month follow-up.
MethodsPatients with medically uncontrolled advanced PACG with 360° peripheral anterior synechia (PAS) were included in this study. The patients were divided into two groups based on the surgical technique: PEI + GSL + GT and TRAB. Each patient completed a 12-month postoperative follow-up.
ResultsA total of 73 eyes from 71 patients were included in this study, 43 eyes of which received PEI + GSL + GT and 30 eyes of which received TRAB. At 12 months follow-up, the mean preoperative and postoperative IOP was 27.63 ± 11.38 and 16.46 ± 4.04 mmHg in the PEI + GSL + GT group (P < 0.001), and 32.83 ± 13.91 and 15.21 ± 2.58 mmHg in the TRAB group (P < 0.001), respectively. As for success rates, among the 43 eyes in the PEI + GSL + GT group, 35 eyes (81.40%) and 40 eyes (93.02%) achieved complete and qualified success with IOP ≤21 mmHg. In the TRAB group, out of 30 eyes, 25 eyes (83.33%) and 29 eyes (96.67%) achieved complete and qualified success with IOP ≤21 mmHg, respectively. Among the 43 eyes in the PEI + GSL + GT group, 33 eyes (76.74%) and 37 eyes (86.05%) achieved complete and satisfactory success with IOP ≤18 mmHg, respectively. While in the TRAB group, 24 eyes (80.00%) and 27 eyes (90.00%) achieved complete and qualified success, respectively, with IOP ≤18 mmHg. There was no significant difference in visual field (VF) between preoperative and postoperative periods in both groups. All eyes exhibited no serious postoperative complications that threatened vision.
ConclusionsPEI + GSL + GT and TRAB demonstrated comparable efficacy in lowering IOP, reducing medications, and preserving VF in medically uncontrolled advanced PACG. Moreover, PEI + GSL + GT exhibited fewer complications, avoid bleb-related complications and may be a novel minimally invasive alternative for treating advanced PACG.

研究目的：本研究为回顾性观察性研究，旨在对比超声乳化联合人工晶状体植入术（phacoemulsification combined with intraocular lens implantation，PEI）、房角粘连分离术（Goniosynechialysis，GSL）与房角切开术（goniotomy，GT）联合方案，与小梁切除术（trabeculectomy，TRAB），在经药物治疗无法控制的晚期原发性闭角型青光眼（primary angle-closure glaucoma，PACG）患者中，随访12个月的降眼压效果。

研究方法：本研究纳入存在360°周边前粘连（peripheral anterior synechia，PAS）、且经药物治疗无法控制的晚期原发性闭角型青光眼患者。根据手术方式将患者分为两组：PEI+GSL+GT联合组与小梁切除术组，所有患者均完成术后12个月的随访。

研究结果：本研究共纳入71例患者的73只眼，其中43只眼接受PEI+GSL+GT联合方案，30只眼接受小梁切除术。随访12个月时，PEI+GSL+GT组患者术前与术后平均眼压（intraocular pressure，IOP）分别为27.63±11.38 mmHg与16.46±4.04 mmHg（P<0.001）；小梁切除术组患者术前与术后平均眼压分别为32.83±13.91 mmHg与15.21±2.58 mmHg（P<0.001）。
在成功率方面，PEI+GSL+GT组的43只眼中，有35只眼（81.40%）与40只眼（93.02%）达到眼压≤21 mmHg的完全成功与合格成功标准；小梁切除术组的30只眼中，分别有25只眼（83.33%）与29只眼（96.67%）达到上述标准。
当以眼压≤18 mmHg为成功标准时，PEI+GSL+GT组的43只眼中，33只眼（76.74%）与37只眼（86.05%）分别达到完全成功与合格成功标准；而小梁切除术组的30只眼中，分别有24只眼（80.00%）与27只眼（90.00%）达到对应标准。两组患者术前与术后的视野（visual field，VF）均无显著差异。所有受试眼均未出现威胁视力的严重术后并发症。

结论：PEI+GSL+GT联合方案与小梁切除术在治疗经药物控制不佳的晚期原发性闭角型青光眼时，在降眼压、减少用药量及保留视野方面疗效相当。此外，PEI+GSL+GT联合方案的并发症更少，可避免滤过泡相关并发症，或可成为治疗晚期原发性闭角型青光眼的新型微创替代方案。