外路全周缝线小梁切开术对原发性开角型青光眼患者24 h眼压波动规律的影响

Effect of ab-externo circumferential suture trabeculotomy on 24-hour pattern of intraocular pressure in patients with primary open angle glaucoma

摘要:

目的：评估外路全周缝线小梁切开术(CST)对原发性开角型青光眼(POAG)24 h眼压波动规律的影响。

方法：回顾性研究。纳入2021-03/2022-05在我院就诊的药物治疗眼压控制不佳的POAG患者18例18眼，均行CST治疗，分别在术前，术后1 a进行24 h眼压检查(选择时间点为9：00 AM、12：00 AM、3：00 PM、6：00 PM、9：00 PM、12：00 PM、3：00 AM、6：00 AM)，比较术前，术后1 a 24 h眼压均值、峰值及峰值时间、谷值及谷值时间、波动范围及昼夜平均眼压差变化。

结果：术前，术后1 a 24 h眼压曲线均呈现日间下降、夜间升高的变化趋势，下午降至波谷，夜间升至波峰； 与术前相比，术后1 a 24 h眼压谷值、峰值时间较术前提前，术后1 a 24 h眼压均值、峰值、谷值明显下降，波动范围无明显差异，昼夜平均眼压差明显增加。

结论：CST可降低POAG患者眼压，但不改变 24 h眼压波动范围，反而升高昼夜平均眼压差，提示CST不能改善POAG患者昼夜眼压波动。

Abstract:

AIM: To evaluate the effect of ab-externo circumferential suture trabeculotomy(CST)on the 24 h pattern of intraocular pressure(IOP)in primary open angle glaucoma(POAG).

METHODS: This retrospective study included 18 POAG patients who had poor control of IOP from March 2021 to May 2022. The ab-externo CST was performed, and IOP was tested preoperatively and 1 a postoperatively(9:00 a.m., 12:00 a.m., 3:00 p.m., 6:00 p.m., 9:00 p.m., 12:00 p.m., 3 a.m., and 6:00 a.m.). The mean, peak, trough, and range of IOP, as well as the average diurnal-nocturnal IOP change were calculated and compared.

RESULTS: The 24 h IOP curves exhibited a decreasing trend during the diurnal period and an increasing trend during the nocturnal period, reaching a trough in the afternoon and peaking at night; the time of trough and peak IOP occurred several hours earlier compared to preoperative eyes. Postoperatively, the mean, peak, and trough IOP values were significantly lower compared to preoperative levels. The range of fluctuation showed no significant difference, while the average diurnal-nocturnal IOP change increased significantly.

CONCLUSION: CST could reduce IOP of patients with POAG, but could not change the range of IOP fluctuation. However, an increase in the average diurnal-nocturnal IOP change was observed, indicating that CST might not necessarily reduce diurnal-nocturnal IOP fluctuations.