Mandal Anil K, Bhatia Prashant G, Bhaskar Arumugam, Nutheti Rishita
Jasti V. Ramanamma Children's Eye Care Centre, L. V. Prasad Eye Institute, Hyderabad, India.
Ophthalmology. 2004 Feb;111(2):283-90. doi: 10.1016/j.ophtha.2003.05.027.
To determine the long-term surgical and visual outcomes in Indian children with developmental glaucoma operated within 6 months of birth.
Retrospective consecutive, noncomparative case series.
All children with developmental glaucoma who underwent surgery within 6 months of birth over a 12-year period were included.
Two hundred ninety-nine eyes of 157 consecutive patients who underwent primary combined trabeculotomy-trabeculectomy for developmental glaucoma from January 1990 through December 2001 by a single surgeon were studied. However, for the purpose of statistical analysis, only 1 randomly chosen eye of patients with a bilateral affliction (142, 90.4%) was considered.
The main outcome measures were preoperative and postoperative intraocular pressures (IOPs), corneal clarity and diameters, visual acuities, refractive errors, success rate, time of surgical failure, and complications.
The series consisted of 299 primary combined trabeculotomy-trabeculectomy surgeries during 157 anesthesias. The intraocular pressure was reduced from 26.6+/-6.2 mmHg to 14.4+/-4.9 mmHg, with a mean percentage reduction of 41.1+/-28.8 (P<0.0001). The probability of success (IOP<21 mmHg) was 94.4%, 92.1%, 86.7%, 79.4%, 72.9%, and 63.1% at first, second, third, fourth, fifth, and sixth year, respectively (Kaplan-Meier analysis). The mean follow-up period was 26.5+/-25.1 months. Preoperatively, 133 eyes (84.7%) had significant corneal edema. Postoperatively, normal corneal clarity was achieved in 83 of 133 eyes (62.4%) with corneal edema. There were no major intraoperative complications. Postoperatively, 17 eyes (10.8%) had a shallow anterior chamber develop; 3 of these eyes (17.6%) required surgical reformation. There was no incidence of endophthalmitis or any other sight-threatening complication. Data on visual acuity were available in 49 patients (31.2%). At the final follow-up visit, 20 patients (40.8%) had normal visual acuity (best-corrected visual acuity of >/=20/60 in the better eye).
Primary combined trabeculotomy-trabeculectomy is safe and effective for developmental glaucoma when performed within 6 months of birth. It leads to excellent IOP control and moderate visual outcome.
确定出生后6个月内接受手术的印度发育性青光眼患儿的长期手术和视觉效果。
回顾性连续非对照病例系列。
纳入在12年期间出生后6个月内接受手术的所有发育性青光眼患儿。
研究了1990年1月至2001年12月由一名外科医生为发育性青光眼进行原发性小梁切开术-小梁切除术的157例连续患者的299只眼。然而，为了统计分析的目的，仅考虑双侧患病患者中随机选择的1只眼（142只，90.4%）。
主要观察指标为术前和术后眼压（IOP）、角膜清晰度和直径、视力、屈光不正、成功率、手术失败时间和并发症。
该系列包括157次麻醉期间的299例原发性小梁切开术-小梁切除术。眼压从26.6±6.2 mmHg降至14.4±4.9 mmHg，平均降低百分比为41.1±28.8（P<0.0001）。成功（眼压<21 mmHg）的概率在第一年、第二年、第三年、第四年、第五年和第六年分别为94.4%、92.1%、86.7%、79.4%、72.9%和63.1%（Kaplan-Meier分析）。平均随访期为26.5±25.1个月。术前，133只眼（84.7%）有明显角膜水肿。术后，133只角膜水肿眼中有83只（62.4%）达到正常角膜清晰度。术中无重大并发症。术后，17只眼（10.8%）出现前房变浅；其中3只眼（17.6%）需要手术修复。无眼内炎或任何其他威胁视力并发症的发生。49例患者（31.2%）有视力数据。在最后一次随访时，20例患者（40.8%）视力正常（较好眼最佳矫正视力≥20/60）。
出生后6个月内进行原发性小梁切开术-小梁切除术治疗发育性青光眼安全有效。它能实现良好的眼压控制和中等的视觉效果。
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