前房角镜辅助内路小梁切开术治疗原发性儿童青光眼效果观察

Efficacy and safety of gonioscopy assisted transluminal trabeculotomy(GATT)for primary childhood glaucoma

目的评估前房角镜辅助内路小梁切开术治疗原发性儿童青光眼的中远期效果和安全性。设计回顾性病例系列。研究对象2018年4月至2019年7月郑州市第二人民医院前房角镜辅助内路小梁切开术治疗的原发性先天性青光眼(PCG)8例(9眼),手术时平均年龄(2.4±1.5)岁;青少年性青光眼(JOAG)15例(20眼),手术时平均年龄(19.0±7.2)岁。方法回顾患者的病历资料,记录术前、术后末次随访时眼压、抗青光眼药物使用数量以及术中、术后并发症情况。术后不使用降眼压药物时眼压≤21 mmHg为完全成功;使用降眼压药物时眼压≤21 mmHg为条件成功。平均随访(27.5±3.7)个月(24~36个月)。主要指标眼压、抗青光眼药物使用数量、术中及术后并发症。结果术前平均眼压(30.4±12.2)mmHg,平均用药3种(2~5)种。末次随访平均眼压(14.3±3.5)mmHg,平均用药0种(0~3)种,二者均较术前显著下降(P均<0.001)。末次随访手术完全成功率、条件成功率分别为72.4%和93.1%。术后前房出血发生率为100%。术后早期眼压反弹发生率为48.3%(14/29眼),主要发生于青少年性青光眼患者。所有患者均无严重手术并发症发生。结论前房角镜辅助内路小梁切开术治疗原发性儿童青光眼具有较好的中长期降眼压效果及安全性。

Objective To evaluate the efficacy and safety of gonioscopy assisted transluminal trabeculotomy(GATT)for the surgical management of primary childhood glaucoma.Design Retrospective case series.Participants Consecutive 8 primary congenital glaucoma(PCG)patients(9 eyes)with mean age 2.4±1.5 years old and 15 juvenile open angle glaucome(JOAG)patients(20 eyes)with mean age 19.0±7.2 years old underwent GATT between April 2018 and July 2019 by a single surgeon in Zhengzhou Second Hospital.Methods Medical records of patients were reviewed.Intraocular pressure(IOP)and usage of anti-glaucoma medication were compared between before surgery and last visit after surgery.Surgical success was defined as a postoperative IOP of≤21 mmHg with(qualified success)or without(complete success)the use of anti-glaucoma medication.Mean follow-up time was 27.5±3.7 months(range 24-36 months).Main Outcome Measures IOP,number of anti-glaucoma medications,surgical complications.Results Post-operative IOP(14.3±3.5 mmHg)and number of anti-glaucoma medication(0,range 0-3)decreased significantly compared with the pre-operative values(30.4±12.2)mmHg(t=7.4,P<0.001),3(range2~5)(z=-4.7,P<0.001),respectively.The complete success rate was 72.4%and the qualified success rate was 93.1%.Hyphema was seen in all eyes(29/29,100%),14/29(48.3%)eyes had IOP spike in early stage after surgery.There was no severe complications occurred in all cases.Conclusion GATT has a medium and long-term effectiveness and is safety in the management of PCG and JOAG.