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微导管辅助小梁切除术治疗小儿青光眼的两年预后:一项随机对照研究

El, S.Y., Gawdat, G.

期刊名称:Acta Ophthalmologica

卷期:2017年第95卷第8期

摘要

摘要:目的:旨在比较微导管辅助小梁切除术与标准硬式探头小梁切除术治疗儿童青光眼的疗效。方法:将需行小梁切开术治疗原发性先天性或继发性小儿青光眼的患儿随机分为Glaucolight照射微导管小梁切除术和硬式探头小梁切开术。完全成功定义为没有药物下眼内压(IOP<18mmHg。结果:共包括62例患者的62只眼。 5.6±4.8个月的30例患者的30眼行微导管辅助小梁切开术,15只眼(50%)行完全360°切口,15只眼(50%)切除范围250-350度。硬式探针小梁切除组32例年龄(4.4±3.8)月患者的32只眼。2年随访结束时,微导管辅助组的完全成功率和失败率分别为67%和15%,而硬性探头小梁切除术组则为47%和50%(p = 0.006)。术后1,3,6,1224个月微导管组有眼压下降的趋势,6个月时IOP差异有统计学意义(p = 0.004)。微导管组的平均生存时间显着延长(p = 0.01)。结论:术后2年,微导管辅助小梁切开术在原发性先天性青光眼患儿眼压控制和成功率方面仍然取得了较好的效果。微导管组对青光眼再次手术的需求显着降低。

PURPOSE:To compare the outcomes of microcatheter-assisted circumferential trabeculotomy to standard rigid probe trabeculotomy in childhood glaucomas.METHODS:Eyes of children requiring trabeculotomy for primary congenital or secondary paediatric glaucoma were randomized to undergo either trabeculotomy using the Glaucolight illuminated microcatheter, or a rigid probe trabeculotomy. Complete success was defined as an intraocular pressure (IOP) of <18 mmHg without medications.RESULTS:A total of 62 eyes of 62 patients were included. Of these 30 eyes of 30 patients aged 5.6 ± 4.8 months underwent microcatheter-assisted trabeculotomy, with 15 eyes (50%) having a complete 360° cut, while 15 eyes (50%) had an incomplete cut ranging from 250 to 350 degrees. The rigid probe trabeculotomy group included 32 eyes of 32 patients aged 4.4 ± 3.8 months. At the end of the 2-year follow-up period, the complete success and the failure rates were 67% and 15%, respectively, in the microcatheter-assisted group versus 47% and 50% in the rigid probe trabeculotomy group (p = 0.006). There was a tendency towards lower IOP in the microcatheter group at 1, 3, 6, 12 and 24 months postoperatively, with the difference in IOP reaching statistical significance at 6 months (p = 0.004). The mean survival time was significantly longer for the microcatheter group (p = 0.01).CONCLUSION:At 2 years postoperatively, microcatheter-assisted trabeculotomy still yielded superior results in terms of IOP control and success rates in children with primary congenital glaucoma. The need for reoperation for glaucoma was significantly lower in the microcatheter group.

 


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