iTrack光纤微导管360°房角切开治疗原发性先天性青光眼

Treatment of primary congenital glaucoma with iTrack illuminated microcatheter for 360-degree trabeculotomy

目的探讨i Track光纤微导管360°房角切开治疗原发性先天性青光眼(PCG)的临床疗效与安全性。方法采用回顾性分析,将2014年3月-10月采用i Track光纤微导管360°房角切开术治疗的PCG患者作为观察组,将2012年5月-2014年2月采用外路小梁切开联合小梁切除术的PCG患者作为对照组,比较两组术前与术后1天、1周、1月、3月、6月及1年的眼压、角膜横径、视神经杯/盘比值、手术并发症与手术成功率。结果本组资料病人共45眼(34例),其中观察组21眼(15例),对照组24眼(19例)。观察组术前平均眼压(38.6±8.7)mm Hg,角膜横径(15±1.7)mm,杯/盘比值0.77±0.21。对照组术前平均眼压(36.2±11.2)mm Hg,角膜横径(14.8±1.6)mm,杯/盘比值0.78±0.22。术后1天、1周和1月的平均眼压,观察组和对照组差异无统计学意义,术后3月、6月及1年的平均眼压,观察组和对照组差异具有统计学意义(P<0.001)。观察组手术成功率80.9%(17/21),对照组为41.7%(10/24),差异具有统计学意义(P<0.01)。术后并发症总数观察组为14眼,对照组22眼,差异具有统计学意义(P<0.05)。术后1年观察组角膜横径和杯/盘比值与对照组相比,差异无统计学意义(P>0.05)。结论 i Track光纤微导管360°房角切开术是治疗PCG的新术式,初期临床观察显示具有较高的手术成功率、良好的降压效果与安全性,可以作为首选手术方式。

Objective To investigate the clinical efficacy and safety of iTrack illuminated microcatheter for 360-degree trarbeculotomy in the treatment of primary congenital glaucoma （PCG）. Methods Retrospective analysis was used for this study, the PCG patients who underwent 360-degree traeculotomy by iTrack illumi- nated microcatheter during March to October 2014 were in the observation group, and the patients who underwent external trarbeculotomy combined with trabeculectomy during May 2012 to February 2014 were in the control group, intraocular pressure （IOP）, corneal transverse diameter （CTD）, the cup/disk ratio （C/D ratio） of the optic nerve, surgical complications and the success rate of the surgery pre and postoperative 1 day, 1 week, 1 month, 3 months, 6 months and 12 months between the two groups were compared. Results Among 34 cases （45 eyes）, 15 cases （21 eyes） were in the observation group while 19 cases （24 eyes） in the control group. The average IOP of the observation group was （38.6±8.7） mmHg, the CTD was （15＋1.7） mm, and the C/D ratio was 0.77±0.21. The average IOP in the control group was （36.2±11.2） mmHg, the CTD was （14.8±1.6） mm,and the C/D ratio was 0.784-0.22. No difference in the average IOP i postoperative 1 day, 1 week, 1 month, was found between the observation group and the control group, however, the IOP difference were statistically significant （P 〈 0.001） between two groups in 3 months, 6 months and 1 year postoperatively. The success rate （80.9%） in the observation group was significantly higher than that in the control group （41.7%）, P 〈 0.01. The postoperative complications were observed in 14 eyes in observation group and 22 eyes in the control group with the significant difference （P 〈 0.01）. The CTD 12 months post operation was （13.7±2.0） mm in observation group and （14.1±2.3） mm in the control group, C/D ratio was 0.66±0.26 and 0.70±0.27, respectively, P 〉 0.05. Conclusion The iTrack illuminated microcatheter for 360-degree trarbeculotomy in the treatment of PCG is a novel surgical method. The initial clinical observation showed that it has a higher surgical success rate, better IOP reducing efficacy and safety; it can be used as the first line surgical treatment for PCG.