Mandal A K, Gothwal V K, Nutheti R
Jasti V Ramanamma Children's Eye Care Centre, LV Prasad Eye Institute, Hyderabad, India.
Eye (Lond). 2007 Jun;21(6):764-74. doi: 10.1038/sj.eye.6702324. Epub 2006 Mar 31.
To determine the surgical outcome after initial surgery in children with primary developmental glaucoma (PDG).
Six hundred and twenty-four eyes of 360 consecutive patients who underwent primary combined trabeculotomy-trabeculectomy (CTT) for PDG from January 1990 to June 2004 were studied. The main outcome measures were pre- and postoperative intraocular pressures (IOPs), corneal clarity, visual acuities, refractive errors, success rate, time of surgical failure, complications, and factors associated with poor outcome.
IOP reduced from 28.1+/-7.5 to 14.9+/-5.9 mmHg (P<0.0001). Probability of success (IOP<21 mmHg) was 85.2, 80.4, 77.2, 72.6, 66.2, and 57.5% at first, second, third, fourth, fifth, and sixth years, respectively (Kaplan-Meier analysis). The mean follow-up period was 20.3+/-25.6 months (median, 6 months). Preoperatively, 243 eyes (67.5%) had significant corneal oedema. Postoperatively, normal corneal transparency was achieved in 162 eyes (46.0%). Data on Snellen visual acuity were available in 100 patients (27.8%). At the final follow-up visit, 42 patients (42.0%) had normal visual acuity (>or=20/60). Myopia (mean spherical equivalent, 6.1 D) was the most common (75.0%) refractive error. In multivariate analyses, failure increased by three-fold in the presence of preoperative IOP>35 mmHg (hazards ratio (HR)=3.12; 95% confidence interval (CI), 1.4-6.7) and two-fold in cases with a history of prior glaucoma surgery (HR=2.57; 95% CI, 1.1-6.0). There were no major intraoperative complications, bleb-related infection, or endophthalmitis.
This series shows that prolonged IOP control can be achieved in patients with PDG and 42% of the patients gained normal visual acuity.
确定原发性发育性青光眼（PDG）患儿初次手术后的手术效果。
对1990年1月至2004年6月期间连续360例因PDG接受原发性小梁切开术-小梁切除术（CTT）的患者的624只眼进行研究。主要观察指标为术前和术后眼压（IOP）、角膜清晰度、视力、屈光不正、成功率、手术失败时间、并发症以及与预后不良相关的因素。
眼压从28.1±7.5 mmHg降至14.9±5.9 mmHg（P<0.0001）。在第一年、第二年、第三年、第四年、第五年和第六年，成功（眼压<21 mmHg）的概率分别为85.2%、80.4%、77.2%、72.6%、66.2%和57.5%（Kaplan-Meier分析）。平均随访期为20.3±25.6个月（中位数，6个月）。术前，243只眼（67.5%）有明显角膜水肿。术后，162只眼（46.0%）达到正常角膜透明度。100例患者（27.8%）有Snellen视力数据。在最后一次随访时，42例患者（42.0%）视力正常（≥20/60）。近视（平均球镜当量，6.1 D）是最常见的（75.0%）屈光不正。在多变量分析中，术前眼压>35 mmHg时失败率增加三倍（风险比（HR）=3.12；95%置信区间（CI），1.4 - 6.7），有青光眼手术史的病例失败率增加两倍（HR=2.57；95% CI，1.1 - 6.0）。没有重大术中并发症、与滤过泡相关的感染或眼内炎。
本系列研究表明，PDG患者可实现眼压的长期控制，42%的患者获得了正常视力。
