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。

Analysis of Visual Outcomes in Children with Primary Congenital Glaucoma

Objective: To evaluate the visual outcomes in children with primary congenital glaucoma (PCG) whose intraocular pressure (IOP) was controlled after surgery and to analyze the risk factors for vision loss. Methods: This was a retrospective case series that included 45 PCG patients (72 eyes) with an IOP≤21 mmHg following glaucoma surgery from June 2017 to February 2018 at Zhongshan Ophthalmic Center. The following information was collected from medical records: Sex, laterality, age at presentation and at initial glaucoma surgery, age at last visit, preoperative IOP, corneal diameter, axial length, type of initial glaucoma surgery, number of surgeries, antiglaucoma medication before initial surgery and at the last visit, best corrected visual acuity (BCVA), cup-disc ratio and retinal nerve fiber layer thicknessat the last visit,and ocular comorbidity. The BCVAs at the last follow-up were categorized into 3 groups: Good (≥0.4), moderate (0.3-0.1) or poor (<0.1). Onivariate and multivariate analyses were performed to determine the risk factors for visual imparirment (BCVA≤0.3). Results: At the last follow-up, the mean logMAR BCVA was 0.61±0.60. A good BCVA was attained in 54%, moderate in 35% and poor in 11%. The mean spherical equivalent of refraction was -4.07±4.94 D; myopia was the predominant refractive error (50%). The most common ocular comorbidity was corneal opacity (36%). Age at presentation, medication before initial surgery, age at initial glaucoma surgery, number of surgeries and corneal opacity were associated with vision impairment (P<0.1). Multivariate logistic regression analysis showed that multiple surgeries (≥2) (OR=6.252, 95%CI: 1.174-33.285, P=0.032) were associated with BCVA loss. Conclusion: Good BCVA is attainable in about 50% of affected eyes. Multiple surgeries are the main risk factor of vision impairment. Early diagnosis, prompt, effective treatment, and timely management of ocular comorbidities and correction of refractive error safter surgery may reduce the rate of severe visual impairment.