非穿透小梁切除联合缝线引导的小梁切开术对原发性先天性青光眼的疗效评估

Outcome evaluation of non-penetrating trabecular surgery combined with suture trabeculotomy for the treatment of primary congenital glaucoma

目的观察非穿透小梁切除联合缝线引导的近全周小梁切开术治疗原发性先天性青光眼的有效性和安全性。方法采用系列病例观察研究方法,纳入2019年1—11月在江苏省人民医院和南京市儿童医院诊断为原发性先天性青光眼的患儿共29例50眼,其中男21例35眼,女8例15眼;年龄1个月~4岁,年龄中位数为6个月。采用非穿透小梁切除的方法打开Schlemm管后,用麻花状6-0聚丙烯缝线引导完成近全周小梁切开术,并记录术前及术后1周、1个月、3个月、6个月、9个月、12个月和24个月的眼压、角膜直径、杯盘比和并发症,记录术中缝线成功穿过全周Schlemm管的患儿比例及术后手术成功率。结果缝线成功穿过全周Schlemm管的患儿比例为90%,未成功的病例改行Harms刀完成小梁切开术。术前、术后1周、1个月、3个月、6个月、9个月,12个月和24个月患儿平均眼压分别为(35.0±9.5)、(9.9±4.4)、(10.0±4.2)、(9.7±4.4)、(9.0±2.9)、(9.4±4.2)、(9.3±3.3)和(9.5±3.8)mmHg(1 mmHg=0.133 kPa),角膜直径分别为(13.7±1.4)、(13.3±1.4)、(12.9±1.4)、(12.8±1.3)、(12.7±1.2)、(12.6±1.1)、(12.6±1.1)和(12.8±0.4)mm,杯盘比分别为0.81±0.15、0.55±0.22、0.48±0.23、0.45±0.22、0.43±0.21、0.41±0.20、0.40±0.21和0.31±0.19,总体比较差异均有统计学意义(F=141.56、4.55、21.07,均P<0.01)。术后不同时间点患儿眼压、角膜直径和杯盘比均较术前下降,差异均有统计学意义(均P<0.01)。术后12个月,手术完全成功率为93.3%(42/45),条件成功率为100%(45/45)。所有患者术中及术后均未见严重并发症发生。结论非穿透小梁切除联合缝线引导的近全周小梁切开术能够有效治疗原发性先天性青光眼,且未见严重并发症发生。

Objective To investigate the efficacy and safety of non-penetrating trabecular surgery combined with nearly 360-degree suture trabeculotomy for the treatment of primary congenital glaucoma(PCG).Methods An observational case series study was conducted.A total of 29 cases(50 eyes)with PCG,including 21 males(35 eyes)and 8 females(15 eyes),were enrolled in Jiangsu Province Hospital and Nanjing Children's Hospital from January to November,2019.The age of subjects ranged from 1 month to 4 years,and the median age was 6 months.Non-penetrating trabecular surgery was first performed in order to open the Schlemm canal.The cannulation and nearly 360-degree suture trabeculotomy were then performed with the twisted 6-0 polypropylene suture.Intraocular pressure(IOP),corneal diameter,cup-to-disc ratio(c/d)and complications were recorded preoperatively and 1 week,1 month,3 months,6 months,9 months,12 months,and 24 months postoperatively,and the proportion of sutures successfully passed through the Schlemm canal and the success rate of operation were recorded.This study followed the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of The First Affiliated Hospital of Nanjing Medical University(No.2019-SR-198).Written informed consent was obtained from the guardian of each subject prior to entering the study cohort.Results Circumferential cannulation by suture was successfully performed in 90%of the subjects.The Harms trabeculotomy probe was applied in failed cases.Mean IOP was significantly lowered from preoperative(35.0±9.5)mmHg(1 mmHg=0.133 kPa)to(9.9±4.4),(10.0±4.2),(9.7±4.4),(9.0±2.9),(9.4±4.2),(9.3±3.3)and(9.5±3.8)mmHg at postoperative 1 week,1 month,3 months,6 months,9 months,12 months and 24 months,respectively(F=141.56,P<0.01).Mean corneal diameter was significantly reduced from preoperative(13.7±1.4)mm to(13.3±1.4),(12.9±1.4),(12.8±1.3),(12.7±1.2),(12.6±1.1),(12.6±1.1)and(12.8±0.4)mm at postoperative 1 week,1 month,3 months,6 months,9 months,12 months and 24 months,respectively(F=4.55,P<0.01).Mean c/d was significantly reduced from preoperative 0.81±0.15 to 0.55±0.22,0.48±0.23,0.45±0.22,0.43±0.21,0.41±0.20,0.40±0.21 and 0.31±0.19 at postoperative 1 week,1 month,3 months,6 months,9 months,12 months and 24 months,respectively(F=21.07,P<0.01).Forty-two eyes(93.3%)achieved complete success and 45 eyes(100%)achieved qualified success at postoperative 12 months.No severe complications were observed during or after surgery.Conclusions Non-penetrating trabecular surgery combined with nearly 360-degree suture trabeculotomy can effectively treat patients with PCG without any severe complications.