小梁切开联合小梁切除及Schlemm管外壁切除术治疗多次手术后的先天性青光眼

Observation on trabeculotomy combined with trabeculectomy and resection of external wall of Schlemm’s canal for the treatment of congenital glaucoma after multiple surgery

目的评估小梁切开联合小梁切除及Schlemm管外壁切除术治疗多次手术后的先天性青光眼的疗效及安全性。方法回顾性病例系列研究。收集郑州大学第一附属医院2020年10月至2023年2月治疗的多次手术后的先天性青光眼24例(32眼)的临床资料。所有患者均行小梁切开联合小梁切除及Schlemm管外壁切除术治疗。随访2年,观察手术后视力、平均视野缺损值(MD)、视网膜神经纤维层(RNFL)厚度和眼压等情况。结果术后2年,抗青光眼药物数量0(0,3)种,较术前3(3,4)种减少(Z=-3.24,P<0.001)。视力、MD、RNFL厚度与术前相比差异均无统计学意义(t=-0.83、-0.18、0.20;P=0.428、0.859、0.847)。术后1周、1个月、3个月、6个月、1年及2年的眼压分别为(11.44±3.22)、(15.94±2.91)、(17.00±5.19)、(18.31±6.09)、(19.00±5.29)、(18.06±3.13)mmHg(1 mmHg=0.133 kPa)(F=59.36,P<0.001),术后眼压均较术前(37.13±6.56)mmHg下降(t=13.50、11.95、9.94、9.21、10.32、11.47;均P<0.001)。手术完全成功率为67.74%(21/32),条件成功率为12.50%(4/32)。结论小梁切开联合小梁切除及Schlemm管外壁切除术治疗多次手术后的先天性青光眼安全有效。

Objective To evaluate the efficacy and safety of trabeculotomy combined with resection of external wall of Schlemm’s canal for congenital glaucoma after multiple surgery.Methods This was a retrospective case series study.The clinical data of 32 eyes of 24 cases with congenital glaucoma after multiple surgery from Oct.2020 to Feb.2023 in the First Affiliated Hospital of Zhengzhou University were analyzed.All cases received trabeculotomy combined with trabeculectomy and resection of external wall of Schlemm’s canal.The follow-up time was 2 years after surgery.Visual acuity,mean defect of visual field(MD)value,average retinal nerve fiber layer(RNFL)thickness and intraocular pressure were observed.Results The number of the postoperative anti-glaucoma medications[0(0,3)types]was significantly lower than that of the preoperation[3(3,4)types](Z=-3.24,P<0.001).There was no significant difference in visual acuity,MD value or average RNFL thickness before and at 2 years after surgery(t=-0.83,-0.18,0.20;P=0.428,0.859,0.847).The intraocular pressure at 1 week,1 month,3 months,6 months,1 and 2 years after operation were(11.44±3.22),(15.94±2.91),(17.00±5.19),(18.31±6.09),(19.00±5.29),and(18.06±3.13)mmHg(1 mmHg=0.133 kPa)(F=59.36,P<0.001),respectively,which were lower than the(37.13±6.56)mmHg before operation(t=13.50,11.95,9.94,9.21,10.32,11.47;all P<0.001).The complete success rate was 67.74%(21/32)at 2 years after operation,and the conditional success rate of the operation was 12.50%(4/32).Conclusion Trabeculotomy combined with trabeculectomy and resection of external wall of Schlemm’s canal for congenital glaucoma after multiple surgery can effectively control the intraocular pressure and protect visual function.