Autrata R, Helmanova I, Oslejskova H, Vondracek P, Rehurek J
Department of Pediatric Ophthalmology, Faculty of Medicine, Masaryk University Hospital, Brno, Czech Republic.
Eur J Ophthalmol. 2007 Nov-Dec;17(6):928-37. doi: 10.1177/112067210701700610.
The aim of this study is to report the clinical course, effectiveness, and safety of glaucoma drainage implants (Molteno and Baerveldt devices) in primary and secondary childhood glaucomas refractory to conventional surgical treatments and medical therapy.
This retrospective study included 76 children (76 eyes) younger than 18 years who underwent glaucoma drainage device (GDD) implantation in our clinic between 1990 and 2004. The mean age at time of surgery was 6.9+/-5.3 years (range: 4 months to 17.5 years). Intraocular pressure (IOP), visual acuity, corneal diameter, axial length, intraoperative and postoperative complications, and number of glaucoma medications were evaluated. Criteria for success were defined as IOP between 7 and 22 mmHg with or without glaucoma medications, no further glaucoma surgery, the absence of visually threatening complications, and no loss of light perception. Results were compared for children with primary and secondary glaucomas. The mean follow-up was 7.1+/-6.5 years (range: 1.6 to 15.2 years).
Mean preoperative and postoperative IOP was 33.6+/-11.4 mmHg and 17.1+/-6.5 mmHg (p<0.001), respectively. Kaplan-Meier survival analysis showed cumulative probability of success: 93% at 6 months, 91% at 1 year, 82% at 2 years, 76% at 3 years, 71% at 4 years, 67% at 5 years, and 65% at 6 years. There was no difference between patients with primary (n=31 eyes) and secondary glaucoma (n=45 eyes) in terms of cumulative success (p=0.186), final IOP, number of medications, or length of follow-up. On average, the GDI surgery was successful for a mean period of 6.7 years. Fourteen eyes of 76 (18.4%) failed: 10 eyes with uncontrolled IOP, 2 eyes with retinal detachment, and 2 eyes with no light perception. Statistical regression model did not show influence of gender and previous surgery. Lower age at the time of surgery was found to be associated with higher probability of treatment failure.
Molteno and Baerveldt glaucoma drainage implants surgery seems to be safe and effective treatment for primary and secondary pediatric glaucoma refractory to the initial surgical procedure and medical therapy.
本研究旨在报告青光眼引流植入物（莫尔顿和贝尔维尔德特装置）在原发性和继发性儿童青光眼中的临床病程、有效性和安全性，这些青光眼对传统手术治疗和药物治疗无效。
这项回顾性研究纳入了1990年至2004年间在我们诊所接受青光眼引流装置（GDD）植入的76名18岁以下儿童（76只眼）。手术时的平均年龄为6.9±5.3岁（范围：4个月至17.5岁）。评估了眼压（IOP）、视力、角膜直径、眼轴长度、术中及术后并发症以及青光眼药物的使用数量。成功标准定义为眼压在7至22 mmHg之间（无论是否使用青光眼药物）、无需进一步进行青光眼手术、不存在威胁视力的并发症且无光感丧失。对原发性和继发性青光眼患儿的结果进行了比较。平均随访时间为7.1±6.5年（范围：1.6至15.2年）。
术前和术后平均眼压分别为33.6±11.4 mmHg和17.1±6.5 mmHg（p<0.001）。Kaplan-Meier生存分析显示成功的累积概率：6个月时为93%，1年时为91%，2年时为82%，3年时为76%，4年时为71%，5年时为67%，6年时为65%。原发性青光眼患者（n = 31只眼）和继发性青光眼患者（n = 45只眼）在累积成功率、最终眼压、药物使用数量或随访时间方面没有差异。平均而言，GDI手术成功的平均时长为6.7年。76只眼中有14只眼（18.4%）失败：10只眼压控制不佳，2只发生视网膜脱离，2只无光感。统计回归模型未显示性别和既往手术的影响。发现手术时年龄较小与治疗失败的概率较高相关。
莫尔顿和贝尔维尔德特青光眼引流植入物手术似乎是治疗原发性和继发性儿童青光眼的安全有效的方法，这些青光眼对初始手术和药物治疗无效。
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