Postoperative Pilocarpine Use After KDB Goniotomy May Reduce Long-Term Glaucoma Medication Needs

KDB小梁切开术后使用匹罗卡品可能减少长期青光眼药物需求

April 22, 2025

2025年4月22日

Research from the University of Colorado School of Medicine suggests that using pilocarpine eye drops after Kahook Dual Blade (KDB) goniotomy surgery may improve surgical outcomes and reduce the long-term need for glaucoma medications. The findings were published in Current Eye Research by faculty and trainees from the Department of Ophthalmology..

科罗拉多大学医学院的研究表明，在Kahook Dual Blade (KDB)小梁切开手术后使用匹鲁卡品滴眼液可能改善手术效果，并减少长期对青光眼药物的需求。该研究结果由眼科系的教职人员和学员发表在《当代眼科研究》杂志上。

Study Objective: Evaluating Pilocarpine's Post-Surgical Role

研究目的：评估毛果芸香碱的术后作用

KDB goniotomy is a minimally invasive glaucoma surgery (MIGS) performed to enhance aqueous humor outflow by incising the trabecular meshwork. However, postoperative treatment protocols vary, particularly regarding the use of pilocarpine, a cholinergic agent that constricts the pupil and augments aqueous drainage..

KDB小梁切开术是一种微创青光眼手术（MIGS），通过切开小梁网来增强房水流出。然而，术后治疗方案各异，特别是在是否使用匹罗卡品这一缩瞳并增加房水引流的胆碱能药物方面存在差异。

“There currently is not a clear evidence-based consensus on whether the drops are beneficial after the surgery,” said Julia Xia, MD, uveitis fellow and lead author of the study. “This research sought to address whether those drops made a difference.”

“目前尚无明确的循证共识表明术后使用这些滴眼液是否有益，”该研究的葡萄膜炎研究员兼主要作者朱莉娅·夏 (Julia Xia) 医学博士说道。“本研究旨在探讨这些滴眼液是否会产生影响。”

Study Design and Outcomes

研究设计与结果

The retrospective study reviewed 532 KDB goniotomy procedures performed at the Sue Anschutz-Rodgers Eye Center between September 2015 and March 2020. Researchers compared outcomes between patients who did and did not use pilocarpine drops postoperatively.

这项回顾性研究审查了2015年9月至2020年3月在 Sue Anschutz-Rodgers 眼科中心进行的532例KDB小梁切开术。研究人员比较了术后使用和未使用匹罗卡品滴眼液患者的疗效。

Key Findings:

主要发现：

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Higher surgical success was observed in the pilocarpine group at 1 month, 3 months, and 1 year post-surgery.

术后1个月、3个月和1年时，匹罗卡品组的手术成功率更高。

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Success was defined as intraocular pressure (IOP) under 21 mmHg along with either a ≥20% reduction in IOP or reduction in at least one glaucoma medication.

成功定义为眼内压 (IOP) 低于 21 毫米汞柱，同时满足以下任一条件：IOP 至少降低 20%，或至少减少一种青光眼药物的使用。

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Fewer glaucoma medications were required long-term in the pilocarpine group compared to those who did not receive the drops.

长期来看，与未接受滴眼液治疗的患者相比，毛果芸香碱组需要更少的青光眼药物。

Understanding Glaucoma and the KDB Approach

了解青光眼及KDB方法

Glaucoma affects over 4.2 million adults in the U.S., and while there is no cure, treatment focuses on IOP reduction through medications or surgery. The KDB goniotomy, developed by Malik Y. Kahook, MD, uses a dual-bladed instrument to create a clean incision in the trabecular meshwork, enhancing fluid outflow..

青光眼影响着美国超过420万成年人，虽然无法治愈，但治疗重点是通过药物或手术降低眼压。由马利克·Y·卡霍克博士开发的KDB小梁切开术使用一种双刃器械，在小梁网中进行清晰的切口，以增强液体流出。

“If you think of the eye as a sink, we are essentially trying to augment the drain,” explains Xia.

“如果你把眼睛看作是一个水槽，我们本质上是在努力增加排水量，”夏解释说。

Pilocarpine has historically been used to lower IOP, but its pupil-constricting properties also create tension in the drainage pathway, theoretically helping keep the surgical opening functional during the healing period.

毛果芸香碱历史上一直被用于降低眼内压，但其缩瞳特性也会在引流途径中产生张力，理论上有助于在愈合期间保持手术开口的功能。

Clinical Considerations and Patient Impact

临床考虑因素与患者影响

Patients in the study typically used pilocarpine drops for one month postoperatively. The research suggests that this short-term use could lead to long-term reductions in medication burden, an important consideration in managing chronic glaucoma.

研究中的患者通常在术后使用一个月的匹鲁卡品滴眼液。研究表明，这种短期使用可能会导致长期的药物负担减轻，这是管理慢性青光眼时需要考虑的重要因素。

However, pilocarpine is not without drawbacks. Common side effects include:

然而，毛果芸香碱并非没有缺点。常见的副作用包括：

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Headache

头痛

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Blurred vision

视力模糊

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Ocular burning or stinging

眼部灼烧或刺痛感

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Increased risk of retinal detachment

视网膜脱离风险增加

“Drop adherence is a massive barrier to treating glaucoma,” said Cara Capitena Young, MD, co-author and associate professor of ophthalmology. “If we can add a drop short-term that reduces long-term medication needs, it can be a great option for some patients.”

“滴药依从性是治疗青光眼的巨大障碍，”该研究的合著者、眼科副教授卡拉·卡皮特纳·杨（Cara Capitena Young）表示。“如果我们能够短期使用一种滴剂，从而减少长期用药需求，这对某些患者来说将是一个很好的选择。”

Capitena Young emphasized that while not all patients are ideal candidates for pilocarpine, the evidence supports its consideration as a valuable adjunct to KDB goniotomy.

杨队长强调，虽然并非所有患者都是毛果芸香碱的理想候选者，但有证据支持将其视为KDB小梁切开术的有价值的辅助手段。

“Surgeons can use this evidence as one piece of the decision-making process when thinking about what’s best for their patients,” Xia concluded.

“外科医生在考虑患者的最佳利益时，可以将此证据作为决策过程中的一个参考因素，”夏总结道。

Reference:

参考文献：

Julia L. Xia et al, Postoperative Use of Pilocarpine After Kahook Dual Blade Goniotomy in Mild to End-Stage Glaucoma, Current Eye Research (2025). DOI: 10.1080/02713683.2025.2464795

朱莉娅·L·夏等人，《Kahook双刃小梁切开术在轻度至晚期青光眼术后使用匹鲁卡品的研究》，《当代眼科研究》（2025）。DOI：10.1080/02713683.2025.2464795