微导管辅助的小梁切开术治疗原发性先天性青光眼的远期疗效观察

目标评估微导管辅助小梁切开术治疗原发性先天性青光眼的远期效果和安全性。设计回顾性病例系列。研究对象2014年2月至2016年12月北京同仁眼科中心微导管辅助小梁切开术治疗的原发性先天性青光眼患者65例(86眼),手术时年龄2个月~11岁,平均(3.7±2.8)岁。方法术后3、6、9个月以及1、2、3、4、5、6年进行随访。比较术前、术后末次随访时(或手术失败时)眼压及降眼压药物使用数量的变化。术后不使用降眼压药物,且眼压≤21 mmHg为绝对成功;术后需使用降眼压药物控制眼压≤21 mmHg为条件成功。主要指标眼压、抗青光眼药物使用数量、术中及术后并发症,远期手术干预。结果平均随访(46.3±9.9)个月(36~72个月)。35眼为初次手术,51眼具有抗青光眼手术史。术前平均眼压(32.5±6.4)mmHg,平均应用(2.8±0.6)种药物;末次随访平均眼压(15.6±7.9)mmHg,平均用药(0.4±1.0)种,二者较术前均显著下降(P均<0.001)。术后1、3、5年累积绝对成功率分别为90.7%、86.0%、68.8%,累积条件成功率分别为90.7%、88.3%、76.9%。随访至术后5年,累积绝对成功率既往无手术史者(94.3%)比有手术史者(60.2%)高(P=0.04)。无严重手术并发症发生。结论微导管辅助的小梁切开术治疗原发性先天性青光眼长期安全有效。抗青光眼手术史会影响远期手术成功率。     

外路全周或部分小梁切开术治疗原发性先天性青光眼患者对照研究

目的比较外路微导管辅助全周小梁切开术(microcatheter assisted circumferential trabeculotomy,MAT)与Harm刀辅助部分小梁切开术(conventional partial trabeculotomy,CPT)治疗原发性先天性青光眼(primary congenital glaucoma,PCG)患者的疗效。方法回顾性研究。纳入2016年4月至2018年4月在河南省人民医院治疗的PCG患儿,按初次手术方式分为2组,即MAT组与CPT组,术后随访均不少于2 a,观察眼压、并发症、降眼压药物使用情况及角膜透明度等指标,比较两种术式的安全性与有效性。结果共纳入34例(41眼)患儿,MAT组18例(22眼),CPT组16例(19眼),年龄(30.1±28.8)周,MAT组和CPT组术前基线眼压分别为(28.45±3.87)mmHg(1 kPa=7.5 mmHg)、(29.05±2.52)mmHg;末次随访时MAT组和CPT组眼压分别为(15.80±5.69) mmHg、(19.28±7.65) mmHg,均较术前显著降低(均为P<0.0...     

微导管辅助的小梁切开术治疗原发开角型青光眼的远期疗效

目的 评估微导管辅助小梁切开术治疗原发开角型青光眼的远期效果和安全性.设计回顾性病例系列.研究对象2015年10月至2018年5月北京同仁眼科中心接受微导管辅助小梁切开术治疗的原发开角型青光眼患者47例(63眼).方法 所有患者均接受微导管辅助的小梁切开术,术后1、3、6个月,1、2、3、4、5年进行随访.以术后不使用...     

外路小梁切开联合小梁切除术治疗先天性青光眼

目的：评价外路小梁切开联合小梁切除术治疗先天性青光眼的疗效。方法：应用外路小梁切开联合小梁切除术治疗先天性青光眼7例(14眼)。结果：术后7d，14眼眼压降至正常。术后随访平均18mo，13眼眼压控制正常，手术成功率92％，术中常见并发症为少量前房出血，一般存术后1～4d完全吸收，对手术效果无影响。结论：外路小梁切开联合小梁切除术治疗先天性青光眼安全有效。     

外路小梁切开联合小梁切除术治疗婴幼儿型青光眼疗效观察

目的　观察外路小梁切开联合小梁切除术治疗婴幼儿型青光眼的疗效。方法　对 1988～1997年我科用联合手术所做的 48例 (86眼 )病例随访 4～ 12 0月 ,阐述手术要点、并发症的预防和处理 ,及手术失败的原因。结果　眼压控制率出院时 95 3 % ,远期为 92 0 %。手术时年龄 <2岁者 ,远期眼压控制率 (93 7% )略高于 2～ 6岁者 (90 7% ) ,两组间差异无显著性 (P >0 0 5 )。角膜横径分别较术前平均减少 0 6mm和 0 3mm ,两组间差异有显著性 (P <0 0 1)。结论　该手术与其它手术相比并发症无增加 ,成功率高 ,是治疗婴幼儿型青光眼的较好方法。早期发现、早期治疗对预后有重要意义。     

外路微导管辅助的360度小梁切开术治疗青少年性开角型青光眼和原发性开角型青光眼的临床对照研究

目的 评估微导管辅助小梁切开术治疗青少年性开角型青光眼（JOAG）和原发性开角型青光眼（POAG)的临床效果和安全性。设计 回顾性病例系列。研究对象2017年11月至2018年12月北京同仁医院接受微导管辅助的小梁切开术治疗的JOAG患者22例（26眼）,平均年龄（25.2±4.5）岁;POAG患者11例（14眼）,平均年龄（46.3±5.1）岁。方法 回顾患者的病历资料,记录眼压、抗青光眼药物使用数量、术中及术后并发症等。术后1、3、6、12个月随访。术后不使用降眼压药物眼压≤21 mmHg且眼压下降幅度≥20%为成功。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 所有患者均完成了12个月的随访。JOAG组术前平均眼压（30.6±7.5） mmHg,平均应用（3.5±1.0）种药物;术后12个月平均眼压（15.8±3.3 ) mmHg,平均应用（0.5±1.0）种药物,眼压降幅为44.9%±18.0%。POAG组术前平均眼压（25.4±6.2） mmHg,平均应用（3.4±0.9）种药物;术后12个月平均眼压（15.9±3.2） mmHg,平均应用（0.3±0.6）种药物,眼压降幅为35.8%±15.6%。JOAG组、POAG手术成功率分别为76.0%、78.6%。两组降眼压幅度和成功率均无显著性统计学差异（P=0.122、0.855)。均无严重手术并发症发生。结论 微导管辅助小梁切开术治疗JOAG和POAG均具有较好的短期降眼压效果及安全性。（眼科,2021, 30： 20-24）     

原发性先天性青光眼临床治疗研究

目的：观察并分析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：收集原发性先天性青光眼患者51例89眼,应用外路小梁切开联合小梁切除术进行治疗,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（15.21±6.50）mo,术后1,6,12mo手术成功率分别为97%,90%,90%。术后平均眼压较术前显著降低(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     

内窥镜辅助与外路微导管引导的小梁切开术治疗原发性先天性青光眼的有效性和安全性对比

目的 比较内窥镜辅助微导管引导的小梁切开术(EATT)与外路微导管引导的小梁切开术(MAT)治疗合并角膜混浊的原发性先天性青光眼(PCG)的有效性和安全性。设计回顾性病例系列。研究对象2020年1月至2021年10月在徐州市第一人民医院实施EATT手术的PCG患者16例(20)眼及MAT手术者17例(21眼)。EATT组及MAT组的平均年龄分别为(40.4±26.9)个月和(38.3±29.0)个月。方法回顾患者术前及术后1、3、6、9、12个月的病历资料,记录各时间点眼压、局部使用降眼压药物数量、手术成功率及术后并发症。手术完全成功定义为无局部降眼压药物使用时眼压<21 mmHg,条件成功定义为联合局部降眼压药物时眼压<21 mmHg。主要指标眼压、局部降眼压药物数量、手术成功率及术后并发症。结果所有患者随访≥6个月。EATT组术后12个月时眼压(15.8±3.1)mmHg,低于术前的(36.3±7.0)mmHg(Z=-3.408,P=0.001);MAT组术后12个月时眼压(17.2±3.7)mmHg,低于术前的(35.5±6.2)mmHg(Z=-3.519,P<...     

微导管引导的内路小梁切开术治疗原发性先天性青光眼六个月的疗效

目的 评估微导管引导的内路小梁切开术治疗原发性先天性青光眼的效果。设计 回顾性病例系列。研究对象 2018年8月至2019年2月北京同仁眼科中心原发性先天性青光眼患者27例（30眼）。方法 患者接受微导管引导的内路小梁切开术，根据术中全周切开和次全周切开，以及是否有既往手术史分组。术后随访6个月。主要指标 眼压、降眼压药物及术后并发症。结果 术前平均眼压（31.5±6.1）mmHg，用药中位数3种（1~4种）；术后末次随访眼压（15.7±3.6）mmHg，用药中位数0种（0~3种）（P均<0.001）。全周切开组（17眼）及次全周切开组（13眼）的术前眼压及术后末次眼压均无统计学差异（P均＞0.05），但全周切开组的降眼压幅度为（54.7%±10.1%），明显大于次全周切开组（37.5%±16.8%，P=0.002）。初次手术组（16眼）与多次手术组（14眼）术前眼压、术后末次眼压及降眼压幅度的差异均无统计学意义（P均＞0.05）。术后早期均有前房积血, 6眼（20%）术后一过性眼压升高。结论 短期随访结果显示， 微导管引导的内路小梁切开术治疗角膜透明的原发性先天性青光眼是可行的。     

原发性先天性青光眼患者长期手疗效比较分析

目的 评价原发性先天性青光眼患者长期手术疗效.方法 对过去11年间(1997年9月至2008年9月)收入中山大学中山眼科中心首次行手术治疗,并能长期随访到的48例81只眼原发性先天性青光眼患者进行回顾性分析.结果 所有患者在小梁切除术、小梁切开术与联合手术者间手术成功率无明显差异(P=0.492);在随访超过4年者中:Kaplan-Meier分析显示行小梁切除术与联合手术者成功率曲线下降较平稳,其中联合手术者成功率曲线下降最缓慢,但小梁切开术曲线下降较明显(P=0.022).结论 长期随访(≥4年)能更好地评价原发性先天性青光眼术后长期临床疗效;三种手术方式治疗原发性先天性青光眼患者远期成功率均随着时间的延长而下降,但以联合手术组成功率曲线下降最缓慢,其次是小梁切除术组,小梁切开术组成功率曲线下降最明显.术后远期的手术成功率与术后患者随访的依从性相关,患者依从性好术后远期的手术成功率高.     

外路微导管辅助的小梁切开术治疗中晚期原发性先天性青光眼

目的:评估外路微导管辅助的小梁切开术治疗中晚期原发性先天性青光眼的疗效。方法:回顾性研究。纳入2018-08/2019-11在西安市第四医院收治的行外路微导管辅助的小梁切开术治疗中晚期原发性先天性青光眼患儿20例22眼。随访12mo,观察手术前后眼压、使用降眼压药物数量、角膜直径、视神经杯盘比、并发症。结果:平均眼压术前为33.4±9.1mmHg,末次随访时为14.4±5.2mmHg(P<0.001),术前使用降眼压药物为2(2,4)种,术后12mo为0(0,2)种(P<0.001)。角膜直径术前为13.34±0.89mm,术后12mo为13.27±0.78mm(P>0.05)。术前视神经杯盘比为0.85±0.17,术后12mo为0.84±0.16(P>0.05)。所有患者均未发生严重手术并发症。结论:外路微导管辅助的小梁切开术治疗中晚期原发性先天性青光眼安全有效。     

外路小梁切开术治疗先天性青光眼远期疗效分析

目的评价先天性青光眼外路小梁切开术后的远期疗效。方法对近25年间,在同一医院接受外路小梁切开术的先天性青光眼进行回顾性疗效调查。共29例49眼。术后平均随访时间92个月,调查内容包括受检者的眼压、角膜直径等。结果其中的45眼(91.84％）调查时眼压＜21mmHg,平均眼压为(16.84±4.11)mmHg。无严重并发症发生。结论表明该组外路小梁切开术治疗先天性青光眼获得满意的远期效果,有效地控制了先天性青光眼的发展。     

Launching a paradigm for first and redo-surgery in primary congenital glaucoma: institutional experience

AIM: To evaluate the outcome of the initial and the redo-surgeries for primary congenital glaucoma (PCG) correlated to its degree of severity. METHODS: A retrospective study involved patients with PCG presented between 2010 and 2018. Medical records were reviewed to assess the degree of the preoperative severity according to the intraocular pressure (IOP), corneal diameter and corneal edema. Success and failure rates were calculated for both first and redo-surgeries at 6 and 12mo respectively then correlated to the severity of the cases. RESULTS: Complete records were retrieved for 272 eyes (153 patients) with PCG: 43 eyes were mild, 136 moderate and 93 severe. Combined trabeculotomy and trabeculectomy (CTT) had the highest success rate in moderate (96.4%) and severe cases (59.3%) while trabeculotomy had the highest success rate in mild cases (96.3%). Medical records of 88 eyes (63 patients) with recurrent PCG were analyzed, most with severe presentation (59 eyes). Ahmed glaucoma valve (AGV) was used in 67 (76%) eyes and augmented trabeculectomy in 21 (24%) eyes. At 12mo, there was no statistically significant difference between both surgeries in total success rate (P=0.256). For mild cases, success rate was 100% for both surgeries. Severe cases had higher success rates following AGV (87%) than augmented trabeculectomy (20%). Preoperative severity of the disease was an independent factor affecting the failure rate in secondary trabeculectomy but not in AGV. Patients younger than 24mo had higher probabilities of failure following both redo-surgeries with hazard ratio =1.325 and 0.37 for augmented trabeculectomy and AGV respectively. CONCLUSION: Preoperative assessment of the severity of eyes with PCG helps in the selecting the optimal primary and secondary surgery. For first surgery, trabeculotomy is more effective in mild cases whereas; CTT and augmented subscleral trabeculectomy (SST) are appropriate for moderate and severe cases. AGV proved to be superior to augmented SST in severe recurrent cases.     

外路小梁切开联合切除术治疗开角型青光眼

目的确定外路小梁切开联合切除术治疗开角型青光眼的效果。方法对21例（36眼）相对年轻的开角型青光眼患者行小梁切开联合切除术，并与20例（33眼）单行小梁切除术的患者进行比较。结果治疗组随访14例（24眼），平均随访22．5mo，眼压控制率为87．5％（不用药），局部用抗青光眼药物达95．7％。对照组随访16例26眼，平均随访19．3mo，眼压控制率为53．8％（不用药），局部用药为73．1％，两组比较有显著差异。结论外路小梁切开联合切除术治疗相对年轻的开角型青光眼患者比单纯小梁切除术成功率明显提高。     

非穿透性小梁切除联合小梁切开术治疗原发性开角型青光眼

目的观察非穿透性小梁切除联合小梁切开术治疗原发性开角型青光眼的临床效果。方法对10例12眼原发性开角型青光眼患者行非穿透性小梁切除联合小梁切开术,术中应用丝裂霉素C,术后观察视力、前房反应、眼压、滤过泡情况,随诊时间3月。结果10例12眼术前眼压(36.6±11.8)mmHg(1kPa=7.5mmHg),术后1d(6.2±2.8)mmHg,术后1周(7.3±3.7)mmHg,术后2周(9.6±4.2)mmHg,术后1月(12.7±4.7)mmHg,术后2月(11.5±4.2)mmHg,术后3月(12.2±4.4)mmHg。术后视力均达到或高于术前水平。12眼均有功能型滤泡。术中、术后均未出现浅前房及前房炎症反应。有1例术中少量前房出血,于术后1d全部吸收。结论非穿透性小梁切除联合小梁切开术能安全、有效地治疗原发性开角型青光眼,成功率高于单纯性非穿透性小梁手术。     

A case of spontaneously resolved primary congenital glaucoma

Primary congenital glaucoma usually presents as enlarged and hazy cornea at birth or early childhood. The diagnosis is based on a thorough clinical examination under anesthesia. Most cases require surgical intervention as the definitive treatment. In very rare instances, primary congenital glaucoma may arrest and resolve spontaneously. We describe a case of spontaneously arrested and resolved primary congenital glaucoma in a 37-year-old male presenting with large cornea, Haab''s striae, and normal intraocular pressure in one eye. Such a case has not been previously described from the Indian subcontinent.     

Therapeutic effect analysis on the treatment of congenital glaucoma through modified combined trabeculotomy-trabeculectomy

AIM: To evaluate the therapeutic effect and the safety of the treatment of congenital glaucoma through modified combined trabeculotomy-trabeculectomy. METHODS: The clinical data of 27 cases (altogether 42 eyes), which included 7 cases of infants (10 eyes) and 20 cases of teenagers (32 eyes), of congenital glaucoma undertook modified combined trabeculotomy-trabeculectomy were analyzed retrospectively. The parameters evaluated included the post operation visual acuity, the anterior chamber, the filtering bleb, the intraocular pressure, the C/D ratio, visual field, the retinal nerve fiber layer changes and the complications. RESULTS: The follow-up period was 1 to 29mo, averaging 13.3±7.7mo. Upon the last visit after the operation, functional filtering blebs developed in all the involved eyes. The intraocular pressure was controlled under 21 mm Hg, which was decreased by 60% when compared with that before the operation, without using any medication. There were no significant changes in the post operation visual acuity and the retinal nerve fiber layer thickness before and after the operation in teenager group (P＞0.05), and both the post operation C/D ratio and the visual field mean defect (MD) were reduced compared with those before the operation (P<0.05). There were no severe complications in any of the patients. CONCLUSION: The modified combined trabeculotomy-trabeculectomy can effectively reduce the intraocular pressure and control the development of glaucoma in cases of congenital glaucoma. It is a safe and effective operative method for the treatment of congenital glaucoma.     

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.     

Combined trabeculotomy and trabeculectomy: outcome for primary congenital glaucoma in a West African population

Purpose

To evaluate the surgical outcome of combined trabeculotomy–trabeculectomy in Ghanaian children with primary congenital glaucoma.

Materials and methods

A retrospective case series involving 19 eyes of 12 consecutive children with primary congenital glaucoma who had primary trabeculotomy–trabeculectomy from 12 August 2004 to 30 June 2008, at the Korle-Bu Teaching Hospital, Ghana. Main outcome measures were preoperative and postoperative intraocular pressures, corneal diameter, corneal clarity, bleb characteristics, duration of follow-up, surgical success, and complications.

Results

A total of 19 eyes of 12 patients met the inclusion criteria. Six of the patients were males. Mean age at diagnosis was 4.4 (range 2–8) months. Mean age at surgery was 5.9 months (range 3–16). Eight (67%) infants had bilateral disease. Mean duration of follow-up was 13.1 (range 5–38) months. The preoperative mean horizontal corneal diameter was 13.4±1.1(range 12–16) mm. Complete success (intraocular pressure <21 mm Hg) was obtained in 15 (79%) eyes. The probability of success was 94.4, 83.3, 66.7, 44.4, 38.9, 33.3, and 13.3% at 3, 6, 9, 12, 15, 18, and 21 months, respectively (Kaplan–Meier analysis). All eyes had corneal oedema preoperatively. Seventeen eyes (90%) had clear cornea at their last follow-up. Mean preoperative and postoperative intraocular pressures were 30.3±8.8 and 18.1±6.8 mm Hg respectively (P<0.001, t-test). Twelve (63%) eyes had well-functioning blebs at the last follow-up. One eye (5%) developed seclusio pupillae and cataract postoperatively.

Conclusion

The overall success for combined trabeculotomy–trabeculectomy in Ghanaian children with primary congenital glaucoma was 79%. The probability of success reduced from more than 66% in the first 9 months postoperatively to below 45% after that.     

Primary infantile glaucoma (congenital glaucoma)

Primary infantile glaucoma, commonly termed congenital glaucoma or trabeculodysgenesis, is an unusual, inherited connatal anomaly of the trabecular meshwork and anterior chamber angle which leads to obstruction of aqueous outflow, increased intraocular pressure, and optic nerve damage. Its pathogenesis is still disputed; most observers have not been able to document ultrastructurally a continuous endothelial membrane, as initially advanced by Barkan. Medical therapy for primary infantile glaucoma is accorded a supportive role; the primary, definitive treatment is surgical. Both goniotomy and trabeculotomy ab externo give similarly good results in the majority of patients. The prognosis in this disease is related to the time of its initial presentation, initial surgical intervention, degree of optic nerve damage, nature and quality of corneal enlargement and astigmatism, progressive refractive error, and anisometropic amblyopia. The inability to easily quantitate visual acuity and extent of visual loss in neonates makes these parameters less helpful in following patients than measurement of corneal diameter and intraocular pressure. However, even these data should not be relied upon exclusively to determine the quality or quantity of success in primary infantile glaucoma.