Al-Haddad Christiane E, Freedman Sharon F
Duke University Eye Center, Durham, NC 27710, USA.
J AAPOS. 2007 Feb;11(1):23-8. doi: 10.1016/j.jaapos.2006.08.005.
Endoscopic diode cycloablation (ECP) has shown modest efficacy for the management of pediatric glaucomas. Eyes with pediatric glaucoma and corneal opacities pose obstacles to intraocular surgery. We examined the role of ECP in lowering intraocular pressure (IOP) as well as that of endoscopy in facilitating tube shunt placement in these eyes.
Retrospective chart review of 12 eyes (11 patients) with glaucoma and corneal opacities from 12/99 to 9/05. ECP was performed for IOP control with success defined as postoperative IOP < or =21 mm Hg, with or without medications and without procedure-related complications. Success of ECP, repeat ECP, and endoscopically guided tube shunt placement was studied.
Diagnoses included the following: Peters/anterior segment dysgenesis in nine eyes and corneal scar/failed corneal graft in three. Patients included eight females and three males with median age 3 years (0.5 to 10.3) at treatment. Median number of prior surgeries was three; median time to failure was 7.8 months (0.3 to 38). Ten eyes had prior external cycloablation(s). Success of first ECP (mean 6.1 clock hours) was 2/12 (17%), with Kaplan-Meier median survival 12 months. Two treatment failures had repeat ECP, and both failed. Four treatment failures had subsequent tube shunt surgery (three with endoscopic assistance), and all were successful at median follow-up of 33 months (11 to 63). Baseline IOP was 36.8 +/- 11 mm Hg before ECP versus 28.2 +/- 16 mm Hg after first treatment (p = 0.07). Procedure-related complications included chorioretinal detachment in one eye.
ECP had limited success in children with refractory glaucoma. However, with anatomic limitations, endoscopy itself was valuable in facilitating subsequent successful tube shunt surgery.
内镜下二极管睫状体光凝术（ECP）在治疗儿童青光眼方面疗效一般。患有儿童青光眼和角膜混浊的眼睛给眼内手术带来了障碍。我们研究了ECP在降低眼压（IOP）方面的作用以及内镜在这些眼睛中辅助放置引流管的作用。
回顾性分析1999年12月至2005年9月期间12例（11名患者）患有青光眼和角膜混浊的12只眼睛的病历。采用ECP控制眼压，成功定义为术后眼压≤21 mmHg，无论是否使用药物且无手术相关并发症。研究了ECP的成功率、重复ECP以及内镜引导下引流管植入的成功率。
诊断包括以下情况：9只眼睛为彼得斯异常/前段发育异常，3只眼睛为角膜瘢痕/角膜移植失败。患者包括8名女性和3名男性，治疗时的中位年龄为3岁（0.5至10.3岁）。既往手术的中位次数为3次；失败的中位时间为7.8个月（0.3至38个月）。10只眼睛曾接受过外路睫状体光凝术。首次ECP（平均6.1个钟点）的成功率为2/12（17%），Kaplan-Meier中位生存期为12个月。2例治疗失败患者接受了重复ECP，均失败。4例治疗失败患者随后接受了引流管手术（3例在内镜辅助下），在中位随访33个月（11至63个月）时均成功。ECP术前基线眼压为36.8±11 mmHg，首次治疗后为28.2±16 mmHg（p = 0.07）。手术相关并发症包括1只眼睛发生脉络膜视网膜脱离。
ECP在难治性儿童青光眼中的成功率有限。然而，由于解剖学限制，内镜本身在促进随后的引流管手术成功方面具有重要价值。
