小梁切除联合巩膜床切开术治疗晚期青少年型和婴幼儿型青光眼临床效果的初步观察

The effect of trabeculectomy combined with prophylactic sclerotomy as a treatment of late stage juvenile open angle glaucoma and primary congenital glaucoma patients:a primary observational study

目的评估小梁切除联合预防性巩膜床切开术治疗高风险性晚期青少年型开角型青光眼和原发性婴幼儿型青光眼的安全性及疗效。方法回顾性系列病例研究。纳入2006年11月至2012年4月就诊于复旦大学附属眼耳鼻喉科医院眼科具有发生脉络膜渗漏及脉络膜上腔出血高危因素的28例晚期青少年型开角型青光眼(33只眼)及12例原发性婴幼儿型青光眼患者(15只眼)的临床及随访资料,所有患者在进行全面的眼科检查后,行常规小梁切除联合预防性巩膜床切开术治疗(附手术视频),术后随访眼压、最佳矫正视力、视盘杯盘比和视野。观察手术并发症,评价手术治疗效果。全部患者均随访至少1年。手术完全成功定义为未用药情况下,眼压为6~18mmHg(1 mmHg=0.133kPa);手术部分成功定义为在局部使用降眼压药物的情况下,眼压为6~18mmHg。手术成功率的分析使用Kaplan-Meier生存曲线。结果40例患者确诊年龄(13.2±9.4)岁,其中男性22例,女性18例,术后随访时间为(31.8±15.9)个月。Kaplan-Meier分析显示术后第3年手术完全成功率为75.8%,部分成功率为90.0%。此系列病例中,1只眼术中发生驱逐性脉络膜上腔出血,2只眼术后发生迟发性脉络膜上腔出血;这3只眼均经保守治疗后自行恢复,未行进一步手术治疗,术后视力无明显下降。结论小梁切除联合预防性巩膜床切开术可有效控制晚期青少年型开角型青光眼及原发性婴幼儿型青光眼患者的眼压,避免脉络膜渗漏及脉络膜上腔出血后的不良预后。

Objective To evaluate the outcomes of trabeculectomy combined with a new prophylactic sclerotomy in late stage juvenile open angle glaucoma (JOAG) and primary congenital glaucoma (PCG) patients at high risks of intraoperative and postoperative suprachoroidal hemorrhage (SCH).Method A retrospective case series study.Thirty-three eyes of 28 JOAG patients and 15 eyes of 12 PCG patients with high risk factors for severe choroidal effusion or SCH were enrolled from November 2006 to April 2012 at Eye and ENT Hospital of Fudan University.The standard trabeculectomy accompanied by prophylactic sclerotomy was performed (video attached).Ophthalmic examinations were performed before and after the surgery.Surgical outcome was assessed in terms of intraocular pressure (IOP),best-corrected visual acuity,optic nerve head cup disc ratio,visual field,and complications.All patients were followed up for at least 1 year.Complete success was defined as an IOP ≥6 mmHg (1 mmHg = 0.133 kPa) but ≤18 mmHg without medication.Qualified success was defined as an IOP ≥6 mmHg but ≤18 mmHg with local application of medications.Kaplan-Meier survival curves were drawn for the success rate calculation.Results The mean age of all 40 patients was (13.2 ± 9.4) years old.And among them,22 patients were male and 18 patients were female.The mean follow-up time was (31.8± 15.9) months.At the postoperative 3rd year,the complete success rate was 75.8%,and the qualified success rate was 90.0%.In our case series,one eye had expulsive SCH intraoperatively and two eyes had delayed SCH postoperatively.All of them were successfully saved without further surgery and with no significant damage to visual function.Conclusion Trabeculectomy combined with prophylactic sclerotomy is a promising technique developed to control IOP in late stage JOAG and PCG patients,which provides a potential intervention to reduce severe consequences of massive choroidal effusion or SCH.