微导管引导的小梁切开术治疗多次手术失败的儿童青光眼的疗效观察

Clinical observation on the treatment of untreatable childhood glaucoma with microcatheter-assisted trabeculotomy

目的 评估微导管引导的小梁切开术治疗经多次传统手术治疗无效、失去再次进行传统手术机会的儿童青光眼患者的有效性.方法 回顾性系列病例研究.收集2014至2016年在首都医科大学附属北京同仁医院眼科中心就诊的15例（16只眼）经多次传统手术治疗无效的儿童青光眼患者的临床资料.所有患者均已接受过2次或2次以上传统手术治疗.所有患者均接受微导管引导的小梁切开术.观察患者术后的眼压、降眼压药物使用情况及术后并发症.采用配对t检验和Wilcoxon符号秩和检验比较术前、术后末次随访眼压及降眼压药物使用数量的变化.结果 15例患者中男性13例,女性2例,年龄2～10岁（中位数为4岁）.其中先天性青光眼11例（12只眼）、迟发儿童期开角型青光眼3例（3只眼）及继发性儿童青光眼1例（1只眼）.儿童青光眼患者术前平均眼压（35.69±6.27）mmHg（1 mmHg=0.133 kPa）使用降压药种类的中位数为3（1～4）,术后末次随访平均眼压下降到（17.88±7.74）mmHg（t=6.97,P＜O.01）,使用降眼压药物种类中位数下降到0（0～3） （Z=-3.15,P＜ 0.01）.末次随访12只眼完全成功,14只眼条件成功.所有患者术中及术后均无严重并发症.结论 15例经过多次传统手术治疗无效的儿童青光眼患者,采用微导管引导的小梁切开术治疗均取得良好的降眼压效果,且无严重并发症发生.

Objective To evaluate the efficacy of microcatheter-assisted trabeculotomy for untreatable childhood glaucoma with traditional surgeries repeatedly.Methods Clinical charts of fifteen cases （16 eyes） with childhood glaucoma patients from Beijing Tongren Hospital were retrospectively analyzed.All eyes had previously received 2 or more traditional anti-glaucoma surgeries.We performed microcatheter-assisted trabeculotomy for these patients.The intraocular pressure （IOP）,numbers of anti-glaucoma medications and post-operative complications were analyzed.The differences between pre-operative and last post-operative IOP and numbers of anti-glaucoma medications were compared using paried t test and wilcoxon signed rank test.Results Thirteen male and 2 female children aged between 2-10 （median：4） years old were recruited.11 cases （12 eyes） were diagnosed as primary congenital glaucoma,3 eyes of 3 cases were late-onset childhood glaucoma,and 1 eye was secondary glaucoma.The mean pre-operative IOP was （35.69-± 6.27）mmHg （1 mmHg=0.133 kPa）on a mean of 3（1-4） medications for childhood glaucoma patients.The mean post-operative IOP decreased to （17.88±7.74）mmHg （t=6.97,P〈0.01） and the median post operative medications decreased to 0（0-3）（Z=-3.15,P 〈 0.01） at last visit.Twelve cases and 14 cases achieved complete and qualified success,respectively.No severe complications were observed for all patients.Conclusion Microcatheter-assisted trabeculotomy got lower introcular pressure results for 15 childhood glaucoma patients with untreadtable traditional surgeries repeatedly with minimal complications.