小梁切开术治疗先天性青光眼的随访观察

Surgical effect of trabeculotomy for congenital glaucoma

目的观察小梁切开术对角膜直径〈13mm和眼轴长度〈23mm的先天性青光眼患儿治疗的作用。方法前瞻性临床观察。选择角膜直径〈13mm和眼轴长度〈23mm的原发性先天性青光眼患儿，术式选择外路小梁切开术。术中未找到Schlemm管或切开Schlemm管后未见到前房少量出血的，不纳入观察。随诊时间为18～36月。观察指标包括眼压、角膜直径和眼底杯盘比等。结果共有8名患儿13只眼入选。随访时间平均29．5±7．8月。术后所有患儿角膜恢复透明。所有的患眼未发现眼底杯盘比继续增大。8例中有1眼在随访结束时眼压为23mmHg，未控制到21mmHg或以下。术后18个月手术成功率为92．3％。结论严格掌握手术指征和正确手术操作，小梁切开术治疗先天性青光眼远期手术成功率高。

Objective To evaluate the surgical effect of trabeculotomy for congenital glaucoma pa- tients with corneal diameter smaller than 13 mm and axial length shorter than 23 ram. Methods Prospective observational study. Trabeculotomy was performed on congenital glaucoma patients with corneal diameter smaller than 13 mm and ocular axial length shorter than 23 ram. Cases were excluded when Schlemm canal cannot be found or small hyphema not reaching the papillary margin cannot be observed after Schlemm canal was incised. All cases were followed up for 18 to 36 months. Main outcome items include intraocular pres-sure, corneal diameter and cup to disc ratio of optic nerve head. Results 13 eyes of 8 patients were en- rolled in the study. Mean follow-up period was 29.5 ± 7.8 months. All corneas recovered transparent after operation. There was no increase in cup to disc ratio of optic nerve head during following up. In eight cases, only one eye＇ s intraocular pressure was 23 mm Hg and failed to be controlled under 21 mm Hg. The success rate was 92.3% at 18 months postoperatively. Conclusion Following surgical indications strictly and per-forming operation correctly are critical for high long - term success rate of trabeculotomy for congenital glau-coma.