Chen T C, Walton D S
Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, USA.
Arch Ophthalmol. 1999 Sep;117(9):1144-8. doi: 10.1001/archopht.117.9.1144.
To report the long-term success and complications of modified goniosurgery to prevent aniridic glaucoma, an entity that typically is difficult to control medically or surgically.
A retrospective review of the medical charts.
Fifty-five eyes in 33 patients who had aniridia without glaucoma and who underwent goniosurgery were identified. Ninety-one procedures were performed on the 55 eyes by 1 surgeon (D.S.W.). Each eye had an average of 1.65 procedures and an average of 200 degrees of goniosurgery. Average age at time of initial goniosurgery was 36.6 months. There were no operative complications. No eye had a decrease in visual acuity at last follow-up. All eyes had a preoperative intraocular pressure (IOP) less than 21 mm Hg. At last follow-up (average, 9 years 6 months; range, 8 months to 24 years), 49 eyes (89%) had IOPs less than 22 mm Hg without medications. The remaining 6 eyes (11%) had IOPs of 22 mm Hg or less with up to 2 types of eyedrops.
Without prophylactic goniotomy, aniridic glaucoma may be expected in half of patients, and when it occurs, it is extremely difficult to control. Prophylactic goniosurgery in selected eyes of young patients with aniridia may be effective in preventing aniridic glaucoma.
报告改良前房角手术预防无虹膜性青光眼的长期疗效及并发症，无虹膜性青光眼通常在药物或手术治疗上都很难控制。
对病历进行回顾性研究。
确定了33例无青光眼的无虹膜患者的55只眼睛接受了前房角手术。1名外科医生（D.S.W.）对这55只眼睛进行了91次手术。每只眼睛平均接受1.65次手术，平均进行200度的前房角手术。初次前房角手术时的平均年龄为36.6个月。无手术并发症。在最后一次随访时，所有眼睛的视力均未下降。所有眼睛术前眼压（IOP）均低于21 mmHg。在最后一次随访时（平均9年6个月；范围8个月至24年），49只眼睛（89%）在未使用药物的情况下眼压低于22 mmHg。其余6只眼睛（11%）使用最多2种眼药水后眼压为22 mmHg或更低。
若不进行预防性前房角切开术，预计半数患者会发生无虹膜性青光眼，且一旦发生，极难控制。对选定的年轻无虹膜患者的眼睛进行预防性前房角手术可能有效预防无虹膜性青光眼。
