先天性青光眼的检查和诊断

先天性青光眼的临床诊断主要依靠症状和体征。症状有畏光、流泪和睑痊挛;体征包括眼压高、角膜扩大、水肿、后弹力层破裂、Haab线、房角结构改变、杯/盘比加大、屈光不正、眼轴增长。本文综述了婴幼儿的眼压、角膜、房角、眼底、轴长的检查方法;收集了早产儿、新生儿和婴幼儿的正常眼压、角膜横径、轴长等生理指标,讨论了先天性青光眼的体征发生的原因及对诊断的意义;描述了前房角的结构、分型及对治疗的意义。     

先天性青光眼小梁切除术中暴发性脉络膜出血1例

患者 ,男 ,8岁。自幼双眼畏光、流泪、眼球扩大 ,曾于1997年在某医院行双眼滤帘切除术 ,术后右眼仍继续扩大 ,畏光、流泪未消失。又于 1999年 8月 2日来我科住院。体检 :视力 :右光感 (± ) ,左 0 .0 8。右眼球结膜轻度混合性充血 ,角膜扩大 ,直径 14mm,呈雾状混浊、水肿 ,后弹力层断裂 ,房闪(- ) ,KP看不清 ,前房中深 ,外上方虹膜根切孔可见。瞳孔呈椭圆形散大 ,直径 6 .5 mm大小 ,对光反应消失 ,晶状体位置正 ,未见混浊 ,眼底模糊。测眼压右 10 / 4=43.4m m Hg,左5 .5 / 4=2 0 .6 mm Hg。全身检查及化验均正常。诊断 :(1)先天性青光眼 (…     

先天性青光眼患儿房水及血清疱疹病毒抗体检测分析

目的研究原发性先天性青光眼(PCG)患儿房水及血清中的疱疹病毒感染情况,并比较分析病毒抗体阳性和阴性PCG患儿临床特点的差异。方法抽取13例PCG患儿首次手术眼13眼的房水及血清,采用酶联免疫吸附试验(ELISA)检测房水单纯疱疹病毒(HSV)、水痘-带状疱疹病毒(VZV)、巨细胞病毒(CMV)Ig G抗体,血清中HSV、VZV、CMV Ig G和Ig M抗体,并采用聚合酶链反应(PCR)验证房水中病毒情况。抽取13例老年性白内障患者的房水作为房水对照组;抽取50例同年龄健康儿童外周血作为血清对照组。对PCG疱疹病毒抗体阳性组和阴性组间年龄、性别、眼别、最高眼压、杯盘比、角膜直径、房角结构、Haab纹等临床特点进行比较分析。结果 13例PCG患儿中9例(69.2%)血清疱疹病毒抗体检测阳性,对照组50例儿童无血清疱疹病毒抗体检测阳性病例;在所有13例PCG患儿中,房水病毒抗体阳性1例(CMV-Ig G),另1例CMV PCR阳性,此2例患者血清疱疹病毒Ig G抗体检测均为阳性,其余房水样本及对照组房水病毒检测均为阴性。PCG患儿中,起病最高眼压、角膜直径、杯盘比和Haab纹所占比例在病毒阳性组和阴性组间差异均无统计学意义。结论超过一半(69.2%)的PCG患者存在血清疱疹病毒抗体阳性。病毒阳性组与阴性组的起病最高眼压、角膜直径、杯盘比及Haab纹占比基本相似。     

先天性青光眼

先天性青光眼是一种少见的、每12500个活婴中有一个罹患(1/12500)青光眼。先天性青光眼发生在儿童期。最常见的先天性青光眼是原发性婴儿型青光眼。原发性婴儿型青光眼可以按发病年龄来分类。原发性婴儿型青光眼发生年龄不到3月时,其中90%是双侧性的。幸而,先天性青光眼并不总是与早熟和其他先天异常相关。一旦已经怀疑是先天性青光眼,即应对患婴进行检查。如果不到3个月的婴儿发生青光眼,则角膜对眼压的升高是非常敏感的,角膜的透明度和横径没有改变。角膜直径、眼压水平、C/D 比两两之间有定量关系。本文还介绍了较新的测量角膜直径的技术。本文也论证了角膜直径与用超声波测量的眼轴长度的关系,表明角膜直径的敏感度要大于眼轴长度的敏感度。一月以上的婴儿要在全麻下检查以便准确测量角膜直径、C/D 比、眼压和房角表现。各种全麻技术一般都会影响眼压水平。本文介绍了较新的、不影响眼压的全麻技术。治疗:虽然药物治疗,特别是噻吗心胺有些奏效,但是原发性婴儿型青光眼的治疗还是手术治疗。本文指出噻吗心胺的安全性及成功率。房角切开术和小梁切除术已被广为采纳。但是,当房角切开术和小梁切除术都不能控制原发性婴儿型青光眼时,也要试行采取其他改良泄液线的术式。本文将描述这些改良术式。85%以上的原发性婴儿型青光眼的眼压均能控制在低于25mm Hg。然而,视觉预后依然是与发生青光眼时眼功能与术后弱视处理有关。视觉预后并非想象的那么严重。有幸,本病的遗传方式的提出使我们能够提供遗传咨询。既然有关青光眼的处理与治疗已有很多进展,那么青光眼的诊断不再意味着就是盲目。     

房角入口分离术治疗原发性婴幼儿性青光眼

原发性婴幼儿性青光眼 (prim ary infantile glaucoma)即一般意义上的先天性青光眼 (congenital glaucom a) ,因出生时已有小梁或房角发育异常 ,大部分出现先天性婴幼儿性青光眼三联症 (畏光、流泪、眼睑痉挛 )和眼球增大、角膜混浊等典型症状而就诊 ,一般在 1周岁内即被发现 ,但由于这种始发于子宫内的先天性青光眼出生时就有眼球增大、角膜混浊和不可克服的弱视存在 ,所以愈后很差 ,当属眼科重症 ,我科1995年 2月～ 2 0 0 0 0年 5月对收治的 13例 (15眼 )患儿施行房角入口分离术 ,疗效满意 ,报告如下。一、对象与方法1.临床资料 :本组病例…     

原发性婴幼儿青光眼(先天性青光眼)

原发性婴幼儿青光眼(primary infantil glaucoma)一般称为先天性青光眼(congenital glaucoma)。是一种先天遗传性小梁或前房角发育异常,阻塞房水排出而致的新生儿、婴幼儿青光眼。表现为眼压增高,角膜增大、水肿,视乳头凹陷。不典型者可较晚发病,即在眼球不能完全膨胀时出现,称为青少年性青光眼(juvenile glaucoma)。与此相反,继发性婴幼儿青光眼系指新生儿和婴幼儿期伴有结构异常,错构瘤性、代谢     

先天性青光眼50例临床与病理

先天性青光眼系胎儿期前房角发育异常所致,有的在出生时已存在病变,也有在生后数周或数年出现。临床特点为畏光、高眼压、角膜混浊,大角膜眼球扩大,晚期有青光眼性视神经萎缩等,是儿童主要致盲眼病之一。     

发育性青光眼30例报告

一般地、人们将先天性青光眼分婴幼儿型和发育型两种。前者为出生时或6岁前发病,临床表现畏光、流泪、眼球扩大、角膜混浊,易于被发现。后者多在10～30岁之间发病,无明显的临床症状,常被漏诊或误诊,以致使一个在其它方面健康而有漫长岁月的年轻人残废,因     

原发性青光眼患者抑郁与焦虑心理状况调查分析

目的 评价原发性青光眼患者抑郁与焦虑心理状况并分析其影响因素.方法 对24例原发性闭角型青光眼(PACG)、26例原发性开角型青光眼(POAG)和对照组(n=24)进行患者健康问卷(PHQ)调查,并对问卷评分进行比较和对年龄、性别等因素进行多重线性回归分析.结果 PACG、POAG和对照组抑郁症状阳性率分别为33.3％、19.2％和8.3％,焦虑症状阳性率分别为37.5％、26.9％和8.3％.PACG组抑郁(P =0.027)、焦虑(P=0.004)程度高于对照组,POAG与PACG和对照组差异不明显(P＞0.05).抑郁焦虑评分呈正相关(P＜0.01),抑郁(β=m.149,P=0.029)焦虑(β=-0.204,P=0.025)分别与年龄呈负相关,与性别无关.结论 PACG抑郁焦虑程度高于正常人,PACG与POAG之间无明显差异.青光眼患者抑郁焦虑状况与年龄相关,与性别无关.     

玻璃体内异物致真菌性眼内炎1例

1 临床资料 患者,男,25岁,农民.左眼被铁屑击伤、畏光流泪、视力下降10d,于6月21日收入院.左眼专科检查:视力手动/眼前;眼压:29.2 mmHg(1 kPa=7.5 mmHg),球结膜充血( ),角膜偏颞侧见一斜行闭合伤口,前房内白色积脓2 mm,与鼻侧相应处虹膜有一闭合穿通伤口,晶状体皮质混浊,眼科B超示:玻璃体条状混浊.诊断:(1)左眼球内异物;(2)继发性青光眼;(3)感染性眼内炎.     

Childhood glaucoma profile in Dakahelia, Egypt: a retrospective study

AIM: To analyze childhood glaucoma regarding its demographics, presentations, different causes and surgical modalities used among patients in Dakahelia and to apply the Childhood Glaucoma Research Network (CGRN) classification retrospectively to evaluate its convenience. METHODS: A retrospective study in which the medical files of all glaucoma patients <16 years old presented to Mansoura Ophthalmic Center, Mansoura University from 2014 to 2017, were retrieved and analyzed. Collected data included: age, gender, laterality, visual acuity (VA), refraction, intraocular pressure (IOP), corneal diameter, cup-disc ratio, types and number of surgeries and antiglaucomatous drugs (AGD) at the first and last visit. Prevalence of different subtypes was calculated and means of clinical features were compared. RESULTS: A total of 305 eyes of 207 patients were included classified into 6 groups: primary congenital glaucoma (PCG), juvenile open angle glaucoma (JOAG), glaucoma associated with systemic disease, glaucoma associated with ocular anomalies, acquired glaucoma and glaucoma following cataract surgery. PCG was the predominant type (55.1%) followed by acquired glaucoma (29.5%). Males represented 63.8% of the whole studied patients. Glaucoma associated with ocular anomaly group showed the youngest age at diagnosis (21.9±30.0mo). The shortest corneal diameter was recorded in post cataract group (10.4±0.5 mm). Highest cup-disc ratio was found in the PCG group (P<0.0005). Glaucoma associated with systemic disease presented with the highest baseline IOP (34.5±5.0 mm Hg). All the cases with PCG were treated surgically with 21.8% required more than one surgery. The majority of the patients (74.2%) in the acquired group were treated medically. Combined trabeculotomy-trabeculectomy was the most frequent operation done, accounting for 34.5% of all primary surgeries. Ahmed valve implantation comprised 87% of the secondary surgeries. Acquired glaucoma group had the highest percent of eyes with good final Snellen''s VA (69.4%), while glaucoma associated with ocular anomaly group had poorest final VA. CONCLUSION: PCG is the most prevalent type of childhood glaucoma, followed by acquired glaucoma especially traumatic hyphema. Combined trabeculotomy-trabeculectomy and Ahmed valve implantation are the most common surgical interventions. CGRN classification is found to provide a consensus skeleton and is recommended to be integrated in our routine ongoing clinical practice.     

原发性先天性青光眼儿童的视力分析

目的：评估原发性先天性青光眼（PCG）患儿抗青光眼术后眼压控制后的视力状况并分析视力损害的 影响因素。方法：回顾性系列病例研究。收集2017年6月至2018年2月在中山眼科中心接受青光眼 手术治疗后眼压控制（眼压≤21 mmHg,1 mmHg=0.133 kPa）的45例（72眼）PCG患儿的详细资料, 包括性别、年龄、受累眼别、发病年龄、术前眼压/角膜直径/眼轴、首次手术年龄、手术类型/次数、 术前及末次随访使用降眼压药情况、视力、末次随访杯盘比及视网膜神经纤维层厚度、眼部伴随疾 病等。按末次随访的最佳矫正视力（BCVA）将患眼分为3组：较好组（≥0.4）、中等组（0.3～0.1）和 较差组（<0.1）。采用t检验、χ2 检验和多因素Logistic回归分析视力损害（≤0.3）的危险因素。结果： 45例患儿在末次随访时的BCVA（logMAR）为0.61±0.60,较好组、中等组及较差组分别占54%、 35%和11%;等效球镜度为（-4.07±4.94）D,近视眼占50%。末次随访最常见的眼部伴随疾病是角 膜混浊（36%）。发病年龄、术前用降眼压药数、首次手术年龄、手术次数及角膜混浊与视力预后相 关（P<0.1）;多因素Logistic回归分析显示多次手术（OR=6.252,95%CI：1.174～33.285,P=0.032）是抗青光眼术后视力预后差的主要危险因素。结论：经手术治疗眼压控制的PCG患眼约50%可获得较 好的视力;多次手术是影响PCG患儿术后视力的主要危险因素。早期发现并尽早手术控制眼压,术 后治疗伴随症状并及时矫正屈光不正,有可能降低PCG患儿严重视力损害的发生率。     

A case of primary congenital glaucoma: a diagnostic dilemma.

BACKGROUND: Primary congenital glaucoma generally presents with a classic clinical triad of photophobia, blepharospasm, and epiphora caused by the corneal changes that occur secondary to increased intraocular pressure (IOP). The condition typically presents bilaterally and is rarely hereditary. Onset is from age 2 months to 2 to 3 years. CASE REPORT: A 2-year, 5-month-old Hispanic boy presented with an enlarged right eye and an intermittent right exotropia, without tearing or photophobia. Examination also found high myopia and an optic nerve cup-to-disc ratio larger in the right than the left eye. Referral to a pediatric ophthalmologist was initiated. On the first examination under anesthesia (EUA), the child was diagnosed with unilateral megalocornea with a normal IOP. He did not have any other typical signs and symptoms of primary congenital glaucoma. An EUA 8 months later led to a diagnosis of primary congenital glaucoma based on the new appearance of Haab's striae, further enlargement of the cornea, and an elevated IOP. At this point, medical management was instituted. CONCLUSION: This case shows the importance of recognizing signs of primary congenital glaucoma so that appropriate management can begin as soon as possible to provide the best visual outcome for a child.     

Evaluating target intraocular pressures in primary congenital glaucoma

Purpose:The aim of this study was to evaluate long-term intraocular pressures that provide stabilization/reversal of glaucomatous neuropathy after surgery in primary congenital glaucoma (PCG).Methods:Prospective evaluation of consecutive PCG patients who underwent trabeculectomy-trabeculotomy and followed up for ≥2 years. Records of regularly performed examination under anesthesia were maintained to ascertain intraocular pressure, (IOP), fundus, refraction and corneal diameter. Outcomes – Primary: cup: disc ratio and intraocular pressure, Secondary: corneal changes and refractive errorResults:A total of 174 eyes of 108 children with PCG had a preoperative IOP of 22.44 ± 9.5 mm Hg. Postoperative review IOP was 11.8 ± 4.5 mm Hg, cup-disc-ratio was 0.52 ± 0.23 and corneal diameter was 12.75 ± 0.9 mm. Primary outcomes: Linear regression analysis showed a significant positive correlation of review IOP with cup disc ratio, P = 0.004. 67.9%, of eyes at a review IOP range of 6-12 mm Hg showed reversal, 14.1%, were stable, at 6-15 mm Hg, while 3.84% showed an increase in cup: disc ratio 16-22 mm Hg. Patients operated before 6 months of age had a significantly smaller final cup-disc ratio, P = 0.0013. Patients with a final cup: disc ratio of >0.9 were significantly older at surgery, P < 0.001. Secondary outcomes: There was a positive correlation of final myopia with review IOP on linear regression analysis, P = 0.012. The final spherical error in eyes having cup disc ratio of ≤ 0.5 was –0.96 ± 4.5 diopters, as against -3.45 ± 7.7 diopters in eyes having cup-disc ratio of 0.6-0.8 and -3.8 ± 6.9 diopters in eyes with cup disc ratio of ≥0.9, P = 0.015. There was no significant change in corneal diameter.Conclusion:Patients operated after 6 months of age had a larger final cup: disc ratio, while postoperative review intraocular pressures over 2 years of at least ≤15 mm Hg in primary congenital glaucoma eyes, commonly lead to reversal/stability of the neuropathy, and a lower incidence and degree of myopia.     

Correlation between surgical success rate and severity of congenital glaucoma

AIM: To study the correlation between severity of primary congenital glaucoma (PCG) and success of three types of surgery. METHODS: This was a retrospective review of all records of patients diagnosed with PCG up to age 1 year who underwent goniotomy, trabeculotomy, or combined trabeculotomy-trabeculectomy with mitomycin C as initial procedure between 1982 and 2002 at the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. 532 paediatric glaucoma patients below age 1 year (820 eyes) with a minimum 1 year follow up were identified. The main outcome measures used for the surgeries were postoperative intraocular pressure, stability of the corneal diameter, and maintenance of corneal clarity. Surgical success was defined as a postoperative intraocular pressure of < or = 21 mm Hg without additional medical or surgical therapy, and with decreased corneal oedema, stabilised corneal diameter, and no additional optic nerve damage for at least 1 year after surgery. Complications, time of surgical failure, and follow up were recorded. RESULTS: The eyes were grouped into mild (249), moderate (342), and severe (229) PCG, based on intraocular pressure, corneal diameter, and clarity. All three surgical procedures resulted in high success rates of 81-100% for the mild form of PCG. Eyes classified with moderate glaucoma had a 13%, 40%, and 80% success rate respectively for goniotomy, trabeculotomy, and combined trabeculotomy-trabeculectomy with mitomycin C. The success rate for severe PCG was 10% and 70% for trabeculotomy and combined surgery respectively. Goniotomy was never done for eyes with this condition. CONCLUSION: Clinical classification of PCG is helpful for surgical decision making. The mild form has a high surgical success regardless of the procedure chosen. Combined trabeculotomy-trabeculectomy with mitomycin C gave the best results for moderate and severe cases of PCG.     

Time of diagnosis, reoperations and longterm results of goniotomy in the treatment of primary congenital glaucoma: a clinical study

Purpose: The aim of our study was to get information about the development of visual acuity, visual field and cupdisc ratio of patients with primary congenital glaucoma after IOP-regulating goniotomy by means of a katamnestic inquiry. The preoperative conditions of IOP, corneal diameter and corneal opacity were related to postoperative findings of visual acuity, visual field and cup-disc ratio reported by the treating ophthalmologists. Methods: 196 patients were contacted, who had a goniotomy in the period from 1965 to 1983 at the University Eye Hospital Würzburg. Out of the 92 returned replies, the address of the treating ophthalmologists could be ascertained from 77 patients. Sixty of the 77 patients fulfilled the inclusion criteria: (1) primary congenital glaucoma and (2) IOP-regulating goniotomy as last surgery. Results: I. In 76% of 106 eyes childhood glaucoma was diagnosed during the first year of life. II. In 72% of 60 eyes/patients with primary congenital glaucoma one goniotomy was sufficient to reach a normal IOP. In 18% a second and in 10% a third goniotomy was necessary, but without influence on the visual outcome. III. Even in the groups of eyes with a preoperative IOP of more than 40 mmHg, preoperative corneal diameter of more than 13 mm and preoperative severe corneal opacity more than 50% reached a visual acuity of 0.4–1.2 and more than 80% had a normal visual field. Only 9% of the eyes showed a cup-disc ratio of 0.6 or more. Conclusions: In primary congenital glaucoma even eyes with high preoperative IOP, large corneal diameters and severe corneal edemas had a good prognosis of visual outcome after goniotomy.Abbreviations CDR cup-disc ratio - LTG low tension glaucoma - PCG primary congenital glaucoma - PG pigmentary glaucoma - VA visual acuity - VF visual field This study was presented in part at the annual meeting of the Association for Research in Vision and Ophthalmology, ARVO, 1996 Fort Lauderdale, Florida, Poster-No. 1903     

小梁切开术治疗原发性先天性青光眼的远期疗效

目的　评价小梁切开术治疗原发性先天性青光眼的远期疗效。方法　回顾性分析 2 2例 (33只眼 )原发性先天性青光眼患者首次行小梁切开术的远期疗效。手术成功的判定标准 :不用或仅局部应用抗青光眼药物 ,眼压≤ 2 1mmHg(1mmHg =0 133kPa) ,且角膜清亮 ,角膜横径和杯 /盘比值减小或未进展者。结果　患者随访时间均在 1年以上 ,平均随访 (5 4 2± 33 2 )个月 ,随访 3年以上者占 72 7%。术后平均眼压 (16 1± 6 2 )mmHg ,较术前眼压 (2 9 9± 11 7)mmHg明显降低(P <0 0 0 1) ;术后平均角膜横径 (12 9± 1 0 )mm较术前 (13 7± 1 4 )mm明显减少 (P =0 0 0 2 ) ,手术前后平均杯 /盘比值差异无显著意义 (P =0 14 8)。手术成功者其杯 /盘比值明显减小 (术前 0 7± 0 2 ,术后 0 6± 0 3,P =0 0 0 7)。根据上述手术成功标准 ,手术成功率 1、3、5年分别为 97 0 %、93 2 %及74 5 % (Kaplan Meier生存分析 )。接受 1次手术者 2 0只眼 ,手术成功率为 70 0 % ;接受 2次以上手术者 13只眼 (39 6 % ) ,再手术成功率为 6 9 2 %。矫正视力≥ 0 4者占 4 1 6 % ,0 1～ 0 3者占 2 9 2 % ,<0 1者占 2 9 2 %。杯 /盘比值 >0 8者是造成低视力的危险因素 (线性回归分析 ,P =0 0 13)。本组 18只眼行视野检查     

Ahmed青光眼引流阀植入治疗先天性青光眼术后眼压失控疗效分析

目的：探讨Ahmed青光眼引流阀植入治疗先天性青光眼术后眼压失控的疗效与安全性。

方法：回顾分析了2011-01/2014-12因先天性青光眼术后眼压失控患者22例22眼,行青光眼引流阀植入术。主要检查指标包括手术前后眼压、角膜直径以及并发症。

结果：术前平均年龄3.74±2.24岁,距上次手术平均2.59±1.78a,术前平均眼压35.22±6.36mmHg,平均水平角膜直径12.79±0.75mm。所有眼术中使用丝裂霉素C 0.3～0.5mg/mL 3～5min,青光眼引流阀植入颞上或鼻上方巩膜赤道部。术后1wk眼压11.4±4.45mmHg,术后12mo随访眼压16.73±7.23mmHg。以眼压<21mmHg为成功标准,术后12mo 16眼(73%)眼压控制。术后6例发生浅前房,均自行恢复。所有患者未发生引流阀排斥及眼内炎、角膜失代偿等严重并发症。

结论：Ahmed青光眼引流阀植入治疗先天性青光眼术后眼压失控,是一种安全、有效的方法。     

原发性先天性青光眼患者术后生活质量的评价

目的 应用儿童和青少年眼病生活质量量表评价原发性先天性青光眼患者的生活质量.方法 横断面研究.首先对5～20岁共51例原发性先天性青光眼术后患者和50例相匹配的正常对照者进行生活质量量表调查,并对量表的信度、效度及反应度进行评价;然后应用该量表对上述原发性先天性青光眼患者术后7年(中位数)末次随访时的生活质量状况进行量表调查.应用SPSS13.0统计学软件对数据进行处理.采用单因素相关分析和多因素逐步回归分析方法评价生活质量得分情况及其与疾病类型、病情严重程度、手术疗效、术后视力、年龄、性别、性格等关系.结果 量表共由23个条目组成,经评定具有较好的信度、效度及反应度;23个条目完全符合原发性先天性青光眼患者生活质量的评价要求.原发性先天性青光眼患者的生活质量量表总分60.02±10.02,比正常对照者的总分(71.41±10.11)明显偏低(t=5.682,P=0.000).单因素相关分析结果表明,病情严重程度(F=24.026,P=0.000)、手术疗效(t=2.638,P=0.009)及术后视力分级(F=11.248,P=0.000)均与生活质量总分相关,病情严重程度(F=12.677,P=0.000)和术后视力分级(F=10.369,P=0.000)与视功能领域得分相关,病情严重程度(F=11.064,P=0.000)和手术疗效(t=2.297,P=0.042)与自理能力领域得分相关;病情严重程度(F=6.869,P=0.020;F=5.721,P=0.019)和性格特征(t=4.352,P=0.009;t=2.297,P=0.042)均与活动交往和精神心理领域得分相关.多因素逐步回归分析结果表明,量表总分和患者病情严重程度(β=-6.985,P=0.001)、术后视力分级(β=-4.978,P=0.003)及性格(β=-5.201,P=0.020)之间均存在明显负相关.结论 该量表符合生活质量量表效度、信度、反应度及易于分析的技术要求,可以适用于5～20岁原发性先天性青光眼患者生活质量的临床研究.影响先天性青光眼患者生活质量的主要因素有病情严重程度、术后视力分级及性格特征.控制病情、提高视力、加强健康教育及心理指导是改善先天性青光眼患者术后生活质量的关键.     

外路小梁切开联合小梁切除术治疗原发性先天性青光眼疗效观察

目的 评价外路小梁切开联合小梁切除术治疗原发性先天性青光眼的临床疗效.方法 随访首次手术行外路小梁切开联合小梁切除术的原发性先天性青光眼患者66例(96只眼),观察术后眼压、角膜横径、杯/盘比值、滤过泡情况及手术并发症,并分析其临床疗效.结果 术后平均随访(11.76±8.5 1)个月,术后1个月、6个月、12个月手术成功率分别为95.83%、92.06%、87.23%.术后平均眼压较术前统计学降低(P＜0.01);杯/盘比值较术前明显减小(P＜0.01);角膜横径手术前后差异无显著意义(P=0.495);手术失败者角膜横径较术前增大(P＜0.05).手术并发症主要有不同程度的前房出血和术后浅前房等.结论 外路小梁切开联合小梁切除术是治疗原发性先天性青光眼安全有效的手术方式之一.

Abstract：

Objective To observe the therapeutic effect of external trabeculotomy combined with trabeculectomy for primary congenitalglaucoma.Methods Sixty-six cases (96 eyes) of primary congenital glaucoma patients treated with exter(n)al trabeculotomy combined with trabeculectomy were observed,the intraocular pressure,cornea diameter,C/D ratio,filter bleb and complication were observed pre- and post-operation,the therapeutic effect were analyzed.Results The mean follow up period wasl 1.76± 8.51months,the successful rate in 1 month,6 months and 12 months after operation was 95.83%,92.06%,87.23% respeectively.The intraocular pressure (IOP) was decreased markedly after operation (P ＜0.01).C/D ratio was decreased markedly (P ＜0.01).There was no statistical difference in cornea diameter between pre- and post-operation (P =0.495).The cornea diameter enlarged in those failed in operations.The complications were various degrees of hypema and shallow anterior chamber.Conclusions External trabeculotomy combined with trabeculectomy is a safe and effective way to treat primary congenital glaucoma.