微导管引导下小梁切开术治疗儿童青光眼效果观察

Clinical observation of microcatheter assisted trabeculotomy on the treatment of childhood glaucoma

目的观察微导管引导下小梁切开术治疗儿童青光眼的安全性和有效性。方法采用前瞻性系列病例观察研究设计,纳入2016年12月至2017年8月在河南省立眼科医院和郑州市第二人民医院就诊的16例22眼儿童青光眼患者,其中男9例12眼,女7例10眼;年龄6个月~8岁,中位数年龄为4岁。所有患儿均接受微导管引导下小梁切开术。分别于术前,术后7 d、1个月、6个月观察并比较患儿眼压变化及术后并发症情况。结果所有患眼中成功完成微导管引导下小梁切开术14例20眼,成功率为90.91%,其中行全切开(切开范围为360°)手术12眼,行次全切开(切开范围为180°~330°)手术8眼,2眼因微导管通过不到90°,术中改行传统Harms刀小梁切开+切除术。完成微导管引导下小梁切开术的20眼术前,术后7 d、1个月和6个月平均眼压分别为(26.55±4.38)、(20.48±3.62)、(13.71±6.35)和(12.67±5.37)mmHg(1mmHg=0.133 kPa),总体比较差异有统计学意义(F=112.771,P<0.001)。末次随访18眼眼压得到控制,其中16眼眼压完全控制,2眼使用降眼压药物后眼压降至正常;2眼术后眼压再次升高,联合应用降眼压药物,眼压仍不能控制至正常水平。所有患者术中及术后均无严重并发症,16眼在术中出现不同程度的前房出血,均在术后l周内吸收。结论微导管引导下小梁切开术治疗儿童青光眼患者降眼压效果良好,并且无严重并发症。

Objective To investigate the clinical efficacy and safety of microcatheter assisted trabeculectomy on the treatment of childhood glaucoma. Methods A prospective case series method was performed.Sixteen childhood glaucoma with 22 eyes were enrolled in Henan Eye Hospital and Zhengzhou Second People's Hospital from December 2016 to August 2017.Nine males with 12 eyes and 7 females with 10 eyes were included, and the age ranged from 6 months to 8 years (median 4 years). All the subjects underwent microcatheter assisted trabeculectomy.The intraocular pressure changes were observed preoperation and 7 days, 1 month and 6 months after surgery, and the postoperative complications were analyzed.This study was approved by the Ethics Committee of Henan Eye Hospital (2018KS-01)and Zhengzhou Secord People's Hospital (No.20161202001), and adhered to the tenets of the Declaration of Helsinki.Written informed consent was obtained from each guardia prior to any medical examination. Results Twenty eyes of 14 patients underwent microcatheter assisted trabeculectomy, the success rate was 90.91%.Twelve eyes were operated with full incision (incision range was 360°), 8 eyes were performed with subtotal incision (incision range was 180°-330°), while the microcatheter could not pass over 90° in 2 eyes and was switch to traditional Harms knife trabeculotomy-trabeculectomy intraoperatively.The intraocular pressures of the 20 eyes that underwent microcatheter assisted trabeculectomy preoperation, 7 days, 1 month and 6 months after surgery were (26.55±4.38),(20.48±3.62),(13.71±6.35) and (12.67±5.37)mmHg, respectively.The intraocular pressures in patients at different time points were statistically significant (F=112.771, P<0.001). At the last follow-up, the intraocular pressures of 18 eyes were controlled.Among them, 16 eyes achieved completely controlled intraocular pressure while 2 eyes returned to normal intraocular pressure after using ocular hypotensive drugs.The intraocular pressure of 2 eyes increased again after operation, and the intraocular pressure could not be controlled after combined use of anti-hypertensive drugs.All patients had no serious complications during and after the operation.Different degrees of anterior chamber hemorrhage occurred in 16 eyes during the surgery, and all the hemorrhages were absorbed within 1 week after surgery. Conclusions For children with glaucoma, microcatheter assisted trabeculectomy can achieve good intraocular pressure reduction effect without serious complications.