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外周小梁切开术与传统房角手术比较:比较原发性先天性青光眼患儿的长期手术成功率和临床预后

Neustein, R.F., Beck, A.D.

期刊名称:American journal of ophthalmology

卷期:2017年第183卷

摘要

摘要:目的:本研究通过青光眼和视力预后比较了外周小梁切开术与传统房角手术治疗青光眼(PCG)的远期疗效。设计:回顾性观察性病例系列。方法:设置:乔治亚州亚特兰大Emory 眼研究中心。这是一项单一机构的回顾性研究,涉及接受外周小梁切开术,标准小梁切开术,前房角切开术随访2年以上的PCG儿童。主要观察指标:术后成功(眼压[IOP] <22毫米汞柱±青光眼药物,无青光眼进展/额外降IOP手术),Snellen等效视力(VA)和最后随访IOP 使用Kaplan-Meier方法估计青光眼术后控制时间,使用Wilcoxon符号秩检验,Mann-Whitney U检验和Fisher精确检验比较房角手术组之间的数值。结果:研究共包括进行外周小梁切开术后的58只眼(33名儿童),标准小梁切开术/切开后的42只眼(27),平均随访7.2±4.08.2±4.5年。外周组与传统组最后随访的成功率分别为81%(58只眼中47只眼)和31%(42只眼中13只眼)(P <0.0001)。最后一次随访时,外周组的VA中值比传统组好(20/30(四分位范围VS 20/70[IQR] 20/2520/70)(20/40 IQR20/200), P = 0.009),需要较少的青光眼药物(0.55±1.2 VS 1.61±1.51P <0.0001),首次手术眼的IOP较低,首次手术眼眼压较低(15.2±3.6 VS 18.2±7.0P = 0.048),以及严重并发症发生率类似(P = 0.065)。结论:在这项回顾性研究中,与传统房角手术相比,PCG儿童外周小梁切开术的远期成功和视力预后更佳。

PURPOSE:This study compares the long-term efficacy of circumferential trabeculotomy to that of conventional angle surgeries in primary congenital glaucoma (PCG), as judged by glaucoma and visual outcomes.DESIGN:Retrospective observational case series.METHODS:Setting: Emory Eye Center, Atlanta, Georgia.STUDY POPULATION:This was a single-institution retrospective study involving children with PCG who underwent circumferential trabeculotomy, standard trabeculotomy, or goniotomy with 2-year follow-up.MAIN OUTCOME MEASURES:Postoperative success (intraocular pressure [IOP] < 22mm Hg ± glaucoma medications, without glaucoma progression/additional IOP-lowering surgery), Snellen-equivalent visual acuity (VA), and IOP at last follow-up. Kaplan-Meier method estimated the probability of glaucoma control vs time postoperatively, and values were compared between angle surgery cohorts using Wilcoxon signed rank tests, Mann-Whitney U tests, and Fisher exact tests.RESULTS:Included were 58 eyes (33 children) after circumferential trabeculotomy and 42 eyes (27 children) after standard trabeculotomy/goniotomy, with mean follow-up of 7.2 ± 4.0 and 8.2 ± 4.5 years, respectively. Postoperative success at last follow-up in the circumferential vs conventional cohorts was 81% (47 of 58 eyes) vs 31% (13 of 42 eyes) (P < .0001). At last follow-up, the circumferential cohort had better median VA than the conventional cohort (20/30 (interquartile range [IQR] 20/25 to 20/70) vs 20/70 (IQR 20/40 to 20/200), P= .009), required fewer glaucoma medications (0.55±1.2 vs 1.61 ± 1.51, P < .0001), had lower IOP in first operated eye (15.2 ± 3.6 vs 18.2 ± 7.0, P= .048), and had comparable incidence of devastating complications (P= .065).CONCLUSIONS:In this retrospective study, circumferential trabeculotomy afforded better long-term success and visual outcomes than conventional angle surgery for children with PCG.

 


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