儿童青光眼的强化小梁切除术

Aims: To report the experience with trabeculectomy augmented with mitomycin C and 5- fluorouracil for the treatment of paediatric glaucoma. Methods: Retrospective, interventional case series design was used. The sample included 17 children (29 eyes) with primary (19 eyes) or secondary (10 eyes) glaucoma who were treated with augmented trabeculectomy as the primary procedure between 1990 and 2002. Data were collected on age and family history, preoperative and end of follow up intraocular pressure, cup/disc ratio (evaluated by drawing), visual acuity, complications, and post-surgery treatment. Results: Patient age at surgery ranged from 1 month to 8 years; most patients (n=14, 82.3% ) were aged less than 1 year (range 1 month-8 months, mean 3.95 (SD 2.56) months); three patients (17.7% ) were aged3, 5, and 8 years. The duration of follow up was 3- 120 months (mean 46 months). Intraocular pressure significantly improved from 21 mm Hg to 60 mm Hg (mean33.1 (10) mm Hg) before surgery to 6- 26 mm Hg (mean 17.1 (6) mm Hg) after, (P < 0.0001). There was no significant change in cup/disc ratio: 0.1- 0.8 (mean 0.42 (0.26)) before and 0.1- 1.0 (mean 0.511 (0.27)) after (P=0.45). In 22 eyes (75.8% ), intraocular pressure was controlled at less than 20 mm Hg and the cup/disc ratio remained stable or improved. The life table success rate for intraocular pressure control remained stable at 86% at the 12, 24, and 36 months and after 48 months decreased to 53% . There was no significant difference in the life table results between primary and secondary glau coma. 14 eyes (48.2% ) had a visual acuity better than 20/120 by the end of follow up. Repeated surgery was necessary in eight eyes (27.5% ), and additional antiglaucoma treatment in 13 (44.8% ). Complications included retinal detachment 1 year after surgery, choroidal detachment, and blebitis (one eye each). Conclusions: Augmented trabeculectomy with mitomycin C and 5- fluorouracil may serve as the primary procedure in a selected group of paediatric patients with glaucoma.

瑞典交互性阈值快速计算视野检查在青春期前特发性颅内高压中的应用

Objective To examine the reliability of Swedish Interactive Thresholding Algor ithm Fast (SITA Fast) visual fields (VFs) in prepubertal idiopathic intracranial hypertension (IIH) and to compare whether age, gender, or severity of visual outcome influenced the reliability o f VF tests. Design Prospective, longitudinal cohort study. Participants Twenty- six prepubertal children (< 11 years of age; mean age, 7.2 years) with IIH. Test ing Children were prospectively followed up using a childoriented program, which included SITA Fast VF tests. Age, gender, and severity of visual outcome were c orrelated with reliability of performance on SITA Fast VFs using a 1-way analys is of variance, point-biserial correlation, and the chi-square test for indepe ndence of observation. Main outcome measures Statistical analyses results that c orrelated the reliability of SITA Fast VFs with age, gender, and visual outcome. Results Three children were treated at the age of 2 years and were unable to pe rform automated VF tests. Four children were treated at the age of 4 years, 3 of whom were able to perform repeatable reliable SITA Fast VF tests. Forty-two ey es of 21 children had an average SIT AFast test time of 4.5 minutes for each eye , compared with 8 minutes using the Fastpac strategy. Age was not associated wit h reliability scores of SITA Fast tests (F=0.971, not significant ns). Gender did not influence the reliability of SITA Fast VF tests (chi-square(1)=0.669, n s), nor did severity of visual outcome (chi-square(2)=3.348, ns). Visual defici ts were observed in 55%of patients at presentation and in 27%of patients after resolution of papilledema. Conclusions The SITA Fast VF tests can be performed from age 4 years and offer a reliable method for shortening test time. A child- oriented follow-up program, which entails a shortened testing time, may improve outcome in prepubertal IIH.