Peripheral Iridectomy With Goniosynechialysis and Goniotomy vs Trabeculectomy for Advanced PACG

作者：Fengbin Lin, Aiguo Lv, Fei Li, Yunhe Song, Lin Xie, Xiaomin Zhu, Li Tang, Yao Zhang, Jingjing Huang, Guangxian Tang, Hengli Zhang, Lan Lŭ, Meichun Xiao, Jiangang Xu, Xin Nie, Mengfei Liao, Yangfan Yang, Kai Gao, Huiping Yuan, Wulian Song, Chengguo Zuo, Ping Lu, Xiaowei Yan, Fengqi Zhou, Zhenyu Wang, Ling Jin, Yu-Ying Peng, Weirong Chen, Keith Barton, Ki Ho Park, Tin Aung, Dennis S.C. Lam, Robert N. Weinreb, Ningli Wang, Clement C. Tham, Sujie Fan, Xiulan Zhang, TVG study group, Xiaohong Liang, Yuhong Liu, Xiaoyan Li · 发表于：JAMA Ophthalmology · 年份：2025 · DOI：10.1001/jamaophthalmol.2025.0757 · 被引用次数：6 · 研究领域：Glaucoma and retinal disorders、Retinal and Macular Surgery、Ophthalmology and Eye Disorders

Importance: The safety and effectiveness of combining surgical peripheral iridectomy (SPI) with goniosynechialysis (GSL) and goniotomy (GT) vs trabeculectomy for intraocular pressure (IOP) reduction remains unknown. Objective: To investigate the safety and effectiveness at 1 year of SPI + GSL + GT vs trabeculectomy in advanced primary angle-closure glaucoma (PACG) without cataract. Design, Setting, and Participants: This noninferiority randomized clinical trial was conducted at 8 tertiary eye centers in China. A total of 88 Chinese patients (88 eyes) with advanced PACG without cataract were enrolled from January 2022 to July 2023. Data were analyzed from August 2024 to September 2024. Mean (SD) patient age was 60.3 (7.3) years, and 52 patients (59.1%) were female. Forty-three patients were randomized to SPI + GSL + GT and 45 were randomized to trabeculectomy; 86 patients (97.7%) completed the 12-month follow-up. Interventions: Participants were randomized 1:1 to receive SPI + GSL + GT or trabeculectomy. Main Outcomes and Measures: The primary outcome was IOP at 12 months (noninferior margin: 4 mm Hg). Secondary outcomes included surgical success (IOP: 5-18 mm Hg, ≥20% reduction from baseline, with or without antiglaucoma medications); postoperative complications and interventions, including bleb massage, suture lysis, or releasable sutures; and number of antiglaucomatous medications prescribed. Results: At 12 months, the SPI + GSL + GT group had a mean (SD) IOP of 15.6 (4.0) ...