Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Comparison of Outcomes of 360-Degree Gonioscopy-Assisted Transluminal Trabeculotomy with or without Cataract Surgery in Pseudoexfoliation Glaucoma: A Retrospective-Comparative Study
Psödoeksfoliasyon Glokomunda Katarakt Cerrahisi ile Kombine Edilen ve Edilmeyen 360-Derece Gonyoskopi-Asiste Translüminal Trabekülotomi Sonuçlarının Karşılaştırılması: Retrospektif-Karşılaştırmalı Çalışma
Hatice TEKCANa , Serhat İMAMOĞLUa , Alev ÖZÇELİK KÖSEa , Yasemin ÜNa , Süleyman KUĞUb
aUniversity of Health Sciences Haydarpaşa Numune Training and Research Hospital, Department of Ophthalmology, İstanbul, Türkiye
bPrivate Physician, İstanbul, Türkiye
Turkiye Klinikleri J Ophthalmol. 2024;33(3):137-46
doi: 10.5336/ophthal.2023-100182
Article Language: EN
Full Text
ABSTRACT
 Objective: To compare of outcomes of 360-degree gonioscopyassisted transluminal trabeculotomy (GATT) with or without cataract surgery (CS) in pseudoexfoliation glaucoma (PXG). Material and Methods: Patients with PXG undergoing 360-degree GATT at a single centre were reviewed retrospectively. The intraocular pressure (IOP) and the medication numbers at postoperative first, third, sixth, 12th, 18th month and at the last visit were recorded. Complete success was defined as IOP reduction ≥20% from baseline and IOP<18 mmHg without medication and further glaucoma surgery. Comparisons were performed between standalone procedure (GATT group) and combined procedure (GATT-CS group). Complication rates were noted. Survival analysis was investigated by Kaplan-Meier test. Results: The preoperative IOP was significantly higher in GATT group (26.5±11.25, n=30) than GATT-CS group (20.5±6.75, n=40) (p=0.001). The GATT group showed significantly higher percentages of IOP reduction after third month, and remained so throughout the follow-up (p<0.05) without significant difference in medication numbers. At the last visit, IOP percentile reductions were 49.58±14.50 in GATT group and 32.73±17.65 in GATT-CS group (p<0.0001). Final median IOP levels were found insignificantly lower in GATT group (12.0±3.5) compared to GATT-CS group (14.0±4.0) (p=0.08). Complete success rates were 70% for GATT and 62.5% for GATT-CS (p=0.51). Two groups did not differ statistically from one another in terms of survival analysis and complication rates (p≥0.05). Toxic anterior segment syndrome was observed only in the combined group in four cases. Conclusion: GATT is an effective surgical method to control IOP in PXG. The IOP-lowering effect of GATT may be less when combined with CS.

Keywords: Cataract surgery; pseudoexfoliation glaucoma; trabeculotomy
ÖZET
 Amaç: Bu çalışmanın amacı, psödoeksfoliasyon glokomunda (PEG) katarakt cerrahisi (KC) ile birlikte veya KC olmadan yapılan 360-derece gonyoskopi-asiste translüminal trabekülotomi (GATT) sonuçlarının karşılaştırılmasıdır. Gereç ve Yöntemler: Tek merkezde 360-derece GATT uygulanan PEG hastaları retrospektif olarak incelendi. Ameliyat sonrası 1, 3, 6, 12, 18. aylarda ve son kontroldeki göz içi basıncı (GİB) ve ilaç sayıları kaydedildi. Cerrahi başarı, ilaç tedavisi ve ilave glokom cerrahisi olmaksızın GİB'nin başlangıca göre ≥%20 azalması ve GİB'nin <18 mmHg olması olarak tanımlandı. Sonuçlar GATT grubu ve kombine grup (GATT-KC grubu) arasında karşılaştırıldı. Komplikasyon oranları kaydedildi. Sağkalım analizi Kaplan-Meier testi ile yapıldı. Bulgular: Ameliyat öncesi GİB, GATT grubunda (26,5±11,25, 30 göz) GATT-KC grubuna (20,5±6,75, 40 göz) göre anlamlı derecede yüksekti (p=0,001). GATT grubu 3. aydan sonra anlamlı derecede daha yüksek GİB düşüşü yüzdeleri gösterdi ve ilaç sayılarında anlamlı bir fark olmaksızın takip boyunca bu şekilde kaldı (p<0,05). Son kontrolde GATT grubunda GİB yüzdelik düşüşü 49,58±14,50, GATT-KC grubunda ise 32,73±17,65 idi (p<0,0001). Son medyan GİB düzeyleri GATT grubunda (12,0±3,5), GATT-KC grubuna (14,0±4,0) göre anlamlı derecede düşük bulundu (p=0,08). Cerrahi başarı oranları GATT için %70, kombine grup için %62,5 idi (p=0,51). Sağkalım analizi ve komplikasyon oranları açısından iki grup birbirinden istatistiksel olarak farklı değildi (p≥0,05). Sadece kombine grupta 4 hastada toksik ön segment sendromu gözlendi. Sonuç: PEG'de GİB kontrolünü sağlamada GATT etkili bir cerrahi yöntemdir. GATT'nin GİB düşürücü etkisi, KC ile kombine edildiğinde daha düşük olabilir.

Anahtar Kelimeler: Katarakt cerrahisi; psödoeksfoliasyon glokomu; trabekülotomi
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