微导管引导的内路小梁切开术治疗原发性先天性青光眼六个月的疗效

Six-month outcomes of ab-interno microcatheter-assisted trabeculotomy in primary congenital glaucoma

目的评估微导管引导的内路小梁切开术治疗原发性先天性青光眼的效果。设计回顾性病例系列。研究对象2018年8月至2019年2月北京同仁眼科中心原发性先天性青光眼患者27例(30眼)。方法患者接受微导管引导的内路小梁切开术,根据术中全周切开和次全周切开,以及是否有既往手术史分组。术后随访6个月。主要指标眼压、降眼压药物及术后并发症。结果术前平均眼压(31.5±6.1)mmHg,用药中位数3种(1~4种);术后末次随访眼压(15.7±3.6)mmHg,用药中位数0种(0~3种)(P均<0.001)。全周切开组(17眼)及次全周切开组(13眼)的术前眼压及术后末次眼压均无统计学差异(P均>0.05),但全周切开组的降眼压幅度为(54.7%±10.1%),明显大于次全周切开组(37.5%±16.8%,P=0.002)。初次手术组(16眼)与多次手术组(14眼)术前眼压、术后末次眼压及降眼压幅度的差异均无统计学意义(P均>0.05)。术后早期均有前房积血,6眼(20%)术后一过性眼压升高。结论短期随访结果显示,微导管引导的内路小梁切开术治疗角膜透明的原发性先天性青光眼是可行的。

Objective To evaluate the effectiveness and safety of ab-interno microcatheter-assisted trabeculotomy in primary congenital glaucoma (PCG). Design Retrospective case series. Participants 27 cases (30 eyes) of PCG with transparent cornea from Beijing Tongren Eye Center in August 2018 to February 2019. Methods Ab-interno microcatheter-assisted trabeculotomy was performed in all patients. Patients were further divided into circumferential trabeculotomy group and partial trabeculotomy group, and without or with previous surgery group. The follow-up is 6 months. Main Outcome Measures IOP, numbers of antiglaucoma medications and postoperative complications. Results The mean baseline IOP was (31.5±6.1) mmHg on a median of 3(range: 1~4) medications. The mean IOP and numbers of antiglaucoma medications at the last follow-up was significantly reduced to (15.7±3.6) mmHg on a median of 0 (range 0~3) medications (both P<0.001). IOPs at baseline and last follow-up were both not significantly different between circumferential trabeculotomy group (17 eyes) and partial trabeculotomy group (13 eyes)(both P>0.05), while the IOP reduction was greater in circumferential trabeculotomy group (54.7%±10.1%) than that in partial trabeculotomy group (37.5%±16.8%,P=0.002). IOPs at baseline and last follow-up, and IOP reduction were all not significantly different between eyes without (16 eyes) or with (14 eyes) previous surgery (all P>0.05). Hyphema was seen in all eyes and 6 eyes (20%) had transient IOP spike in the early postoperative days. Conclusion The short-term follow-up shows that ab-interno microcatheter-assisted trabeculotomy is feasible for the treatment of primary congenital glaucoma with transparent cornea.