目的：探索外路微导管引导360°或120°小梁切开联合虹膜周边切除术对降低眼压(IOP)、减少抗青光眼药物使用以及改善开角型青光眼(OAG)患者安全性和疗效的作用。

方法：回顾性分析。纳入2019年10月至2024年3月期间在恩施地区接受该手术的55例开角型青光眼患者。术前及术后1、3、6、12 mo进行随访，记录IOP、最佳矫正视力(BCVA)、抗青光眼药物使用情况和术后并发症。主要观察指标为术前和术后IOP变化及手术成功率(完全成功：IOP≤18 mmHg且无需药物； 部分成功：IOP≤18 mmHg但需药物辅助)。

结果：术前平均IOP为26.7±4.4 mmHg，术后1、3、6、12 mo均呈持续下降趋势，且各时间点较术前显著降低(均P<0.001)。术后12 mo完全成功率为62%，部分成功率为38%。抗青光眼药物的使用显著减少，多数患者术后12 mo无需药物辅助维持IOP。术前与术后12 mo BCVA无差异(P=0.19)。术后主要并发症为短暂性前房积血(20%)，均于1 wk内自发吸收，未见严重并发症。

结论：外路微导管引导的360°或120°小梁切开联合虹膜周边切除术可显著降低OAG患者的IOP，减少药物依赖，且具有较高的安全性，是一种有效的治疗选择。

METHODS:This retrospective study included 55 patients with OAG who underwent the procedure in the Enshi region between October 2019 and March 2024. Follow-up examinations were conducted at 1, 3, 6, and 12 mo postoperatively to record IOP, best-corrected visual acuity(BCVA), use of anti-glaucoma medications, and postoperative complications. The primary outcome measures were changes in IOP before and after surgery and surgical success rates(complete success: IOP ≤18 mmHg without medication; partial success: IOP ≤18 mmHg with medication).

RESULTS:The mean preoperative IOP was 26.7±4.4 mmHg. Postoperatively, the IOP showed a continuous decreasing trend at 1, 3, 6, and 12 mo, with all time points demonstrating a significant reduction compared with baseline(all P<0.001). At 12 mo postoperatively, the complete success rate was 62%, and the partial success rate was 38%. The use of anti-glaucoma medications was significantly reduced, with most patients maintaining target IOP without pharmacological assistance at 12 mo. No significant difference was observed in BCVA between preoperative and 12-month postoperative assessments(P=0.19). The most common postoperative complication was transient hyphema(20%), which resolved spontaneously within 1 wk, and no severe complications were observed.

CONCLUSION: Ab-externo microcatheter-guided 360° or 120° trabeculotomy combined with peripheral iridectomy significantly lowers IOP, reduces medication dependence, and demonstrates a high safety profile, making it an effective and reliable surgical option for patients with OAG.