Mandal Anil K, Gothwal Vijaya K, Bagga Harmohina, Nutheti Rishita, Mansoori Tarannum
Jasti V. Ramanamma Children's Eye Care Centre, L. V. Prasad Eye Institute, L.V Prasad Marg, Banjara Hills, Hyderabad 500-034, India.
Ophthalmology. 2003 Oct;110(10):1909-15. doi: 10.1016/S0161-6420(03)00671-7.
To determine the visual outcomes and surgical and anesthetic complication rates of patients with newborn glaucoma operated within 1 month of age.
Retrospective, consecutive, noncomparative case series.
All children with newborn glaucoma who underwent surgery between January 1990 and December 2000 were included.
The medical records of 25 consecutive patients (47 eyes) who underwent primary combined trabeculotomy and trabeculectomy either bilaterally in a single session or unilaterally were reviewed retrospectively. Outcomes were evaluated using Kaplan-Meier survival analysis.
Clinical outcome assessment included corneal clarity, intraocular pressure (IOP), bleb characteristics, visual acuity, refractive errors, and identification of surgical and anesthetic complications.
The mean follow-up was 3.1+/-1.8 years (range, 9.5 months-7.4 years). The mean preoperative IOP was 26.9+/-5.2 mmHg (range, 14-42 mmHg). At the final follow-up visit, the mean IOP was 14.5+/-3.8 mmHg (range, 8-28 mmHg). The percentage reduction in IOP was 43.3+/-21.5 (P<0.0001). Twelve-, 24-, and 36-month survival rates for complete success for IOP control were 89.4%, 83.6%, and 71.7%, respectively, which were maintained for 7 years of follow-up. After surgery, complete clearance of corneal edema was achieved in 66% of the eyes. Data on visual acuity was available for 19 patients. Final best spectacle-corrected visual acuity was 20/40 or better in the better eye in 5 patients (26.3%), 7 patients (36.8%) obtained 20/60 or better in the better eye, 8 patients (42.1%) achieved final visual acuity of less than 20/60 to 20/200 in the better eye (low vision), and four patients obtained less than 20/400 visual acuity in the better eye (blind) according to World Health Organization criteria. However, there was no eye with absent perception of light in the better eye. Myopia (mean spherical equivalent, 4.6+/-3.2 diopters) was the most common refractive error, present in approximately half of the eyes (n = 23; 53.8%). There were no significant intraoperative or postoperative complications in any patient. Anesthesia-related complications developed in 2 patients; however, they were resuscitated successfully.
Primary combined trabeculotomy-trabeculectomy offers a viable surgical option in infants that have cloudy corneas at birth as a result of congenital glaucoma. It is associated with a favorable visual outcome and a low rate of anesthetic complications in an Indian population.
确定1月龄内接受手术的新生儿青光眼患者的视力预后以及手术和麻醉并发症发生率。
回顾性、连续性、非对照病例系列研究。
纳入1990年1月至2000年12月期间接受手术的所有新生儿青光眼患儿。
回顾性分析25例连续患者（47只眼）的病历，这些患者均接受了一期双侧小梁切开术和小梁切除术，或单侧手术。采用Kaplan-Meier生存分析评估预后。
临床预后评估包括角膜透明度、眼压（IOP）、滤过泡特征、视力、屈光不正以及手术和麻醉并发症的识别。
平均随访时间为3.1±1.8年（范围9.5个月至7.4年）。术前平均眼压为26.9±5.2 mmHg（范围14至42 mmHg）。在最后一次随访时，平均眼压为14.5±3.8 mmHg（范围8至28 mmHg）。眼压降低百分比为43.3±21.5（P<0.0001）。眼压控制完全成功的12个月、24个月和36个月生存率分别为89.4%、83.6%和71.7%，并在7年的随访中保持。术后，66%的眼睛角膜水肿完全消退。19例患者有视力数据。根据世界卫生组织标准，5例患者（26.3%）较好眼的最终最佳矫正视力为20/40或更好，7例患者（36.8%）较好眼的视力为20/60或更好，8例患者（42.1%）较好眼的最终视力在20/60至20/200之间（低视力），4例患者较好眼的视力低于20/400（失明）。然而，较好眼无光感的患者为零。近视（平均球镜等效度数为4.6±3.2屈光度）是最常见的屈光不正，约半数眼睛（n = 23；53.8%）存在。所有患者术中及术后均无明显并发症。2例患者出现麻醉相关并发症；然而，他们均成功复苏。
一期小梁切开术联合小梁切除术为因先天性青光眼导致出生时角膜混浊的婴儿提供了一种可行的手术选择。在印度人群中，该手术与良好的视力预后和较低的麻醉并发症发生率相关。
