先天性青光眼手术疗效观察

Clinical observation of congenital glaucoma surgery

目的观察手术治疗先天性青光眼的临床疗效。方法收集初诊年龄≤3岁先天性青光眼患者62例(97只眼),按角膜横径以及眼底杯盘比对患者实施不同手术方式治疗,随访观察手术成功率、眼压、角膜横径以及眼底杯盘比。结果外路小梁切开联合小梁切除术72只眼(占术眼74.2%);单纯小梁切开术12只眼(占12.4%);小梁切除术13只眼(占13.4%)。外路小梁切开联合小梁切除术后1、3、6、12及24个月手术成功率分别为95.83%、90.28%、86.67%、84.31%、82.35%。手术成功者术后平均眼压较术前显著降低(P<0.01),杯盘比较术前减小(P<0.01),角膜横径术前术后差异无显著意义(P=0.259),手术失败者角膜横径与杯盘比继续增大。结论外路小梁切开联合小梁切除术是治疗先天性青光眼常用、安全有效的手术术式;角膜横径可做为判断≤3岁先天性青光眼病情控制与否的指标。

Objective To observe the clinical effects of surgical treatment on congenital glaucoma. Methods Author collected data from 62 cases （97 eyes）of congenital glaucoma whom underwent the initial surgery no more than 3 years ago. Different types of surgeries were performed in individual patients according their cornea diameter and fundus cup-disc ratio （C/ D）. Success rate,intraocular pressure （IOP）,cornea diameter and C/ D were followed. Results Trabecu-lectomy plus trabeculotomy was done in 72 eyes （74. 2%）. Trabeculotomy alone was operated in 12 eyes （12. 4%）,and trabeculectomy alone was operated in 13 eyes （13. 4%）. The success rates of trabeculotomy plus trabeculectomy were 95. 83%,90. 28%,86. 67%,84. 31%,and 82. 35% at 1 month,3 months,6 months,12 months and 24 months after the treatment. Intraocular pressure,corneal diameter and C/ D ratio were significantly improved （P 〈 0. 01）. Corneal di-ameter and C/ D continued to increase for patients that the surgery was not successful. Conclusion Trabeculotomy com-bined with trabeculectomy is a commonly used,safe and effective procedure for congenital glaucoma. Cornea diameter can be an indication for the successful treatment for patients of 3 years age or younger.