黏弹物质小管扩张术联合90°小梁切开术治疗原发性婴幼儿型青光眼

Clinical effect of viscocanalostomy with 90° trabeculotomy for primary congenital glaucoma

目的:评价黏弹物质小管扩张术联合90°小梁切开术治疗原发性婴幼儿型青光眼(primary congenital glaucoma,PCG)的临床疗效。方法:采用前瞻性随机对照临床试验研究,将37例50眼首次行手术治疗的原发性婴幼儿型青光眼患者分为两组,试验组25眼行黏弹物质小管扩张术联合90°小梁切开术;对照组25眼行180°小梁切开术。观察比较的指标包括:术前及术后眼内压(intraocular pressure,IOP)、角膜直径、杯/盘比(C/D),随访时间点为1wk,1、3、6mo。患儿均在水合氯醛灌肠下用Schiots眼压计测量眼压、用双脚圆规测量角膜的横径,用检眼镜记录眼底杯盘比值。结果:术后随访6mo,黏弹物质小管扩张术联合90°小梁切开术组术后1wk,1、3、6mo的平均眼压分别为7.51±3.68、11.79±1.84、13.97±2.76、14.51±0.97mm Hg,180°小梁切开术组分别为8.47±2.66、13.88±6.32、15.74±3.20、16.51±2.44mm Hg,均较术前眼压30.74±4.68、31.96±5.15mm Hg明显降低,差异均有显著统计学意义(P<0.01);黏弹物质小管扩张术联合90°小梁切开术组术后3mo平均角膜横径较术前明显减少,差异有统计学意义(P<0.05);术后22眼的杯盘比减小,28眼的杯盘比不进展。手术成功者其杯/盘比值明显减小(术前0.72±0.19,术后0.60±0.24,P=0.007);患者50眼中,术中前房出血11眼(22%),前房是否出血与术后眼压降低情况无关。余患者术后均未出现无浅前房、低眼压、角膜后弹力膜脱离、脉络膜脱离、玻璃体脱出、虹膜粘连及眼内感染等并发症。结论:黏弹物质小管扩张术联合90°小梁切开术治疗原发性婴幼儿型青光眼,具有术后眼压控制效果好,术后并发症发生率低,安全性高的特点。

AIM ： To evaluate the clinical effect of viscocanalostomy combined with 90° trabeculotomy in patients with primary congenital glaucoma（ PCG）.METHODS： A total of 37 patients（ 50 eyes） with primary congenital glaucoma were included in the prospective and randomized trial. These patients were divided into two groups, the study group and the contral group.Viscocanalostomy combined with 90° trabeculotomy was performed in 25 eyes as the study group and 180°trabeculotomy in the other 25 eyes as the control group.The outcomes were measured respectively, including preoperative and postoperative intraocular pressure（ IOP）,corneal diameter and cup /disc ratio detected by Schiots tonometer, compass and ophthalmoscope respectively when patients were under sedation by chloralic hydras coloclysis. All patients were followed up at 1wk,1,3 and 6mo.RESULTS： IOP decreased respectively frompreoperative30. 74 ± 4. 68 mmHg in the study group and 31. 96 ±5. 15 mmHg in the control group to postoperative 7. 51 ±3. 68 and 8. 47 ± 2. 66 mmHg,11. 79 ± 1. 84 and 13. 88 ±6. 32 mmHg,13. 97 ± 2. 76 and 15. 74 ± 3. 20 mmHg,14. 51 ±0. 97 and 16. 51 ± 2. 44 mmHg at 1wk,1,3 and 6mo. The differences were statistically significant（ P〈0. 01）. The postoperative corneal diameter of study group decreased significantly at 3mo after operation（ P〈0. 05）. Theaverage cup / dish ratio decreased in 22 eyes, did not progress in 28 eyes. The patients with successful operation had less cup / dish ratio（ 0. 60 ± 0. 24） than that（ 0. 72 ±0. 19） before operation（ P =0. 007）. In the 50 eyes,there was anterior chamber hemorrhage in 11 eyes（ 22%）,which was not related to the decrease of IOP after operation. The rest patients had no complications,such as shallowanterior chamber, hypotonia, Descemet ＇s membrane detachment,choroidal detachment,prolapse of vitreous,synechia and intraocular infection. CONCLUSION： Viscocanalostomy combined with 90°trabeculotomy can improve the success rates in the patients with PCG,including lowering the postoperative mean IOP and decreasing the complication rates.