Low Sancy, Hamada Samer, Nischal Ken K
Department of Clinical and Academic Ophthalmology, Great Ormond Street Hospital for Children, London, United Kingdom.
J AAPOS. 2008 Apr;12(2):166-72. doi: 10.1016/j.jaapos.2007.09.012. Epub 2007 Dec 21.
To evaluate childhood filtration surgery when using releasable sutures, antimetabolites, and bleb-needling with 5-fluorouracil (5FU).
Retrospective case note review of 30 patients (38 eyes) with childhood glaucoma presenting between 1999 and 2004 to a tertiary pediatric ophthalmology center. Either trabeculectomy or combined trabeculotomy-trabeculectomy using antimetabolites, releasable sutures, and bleb modification was performed. Successful outcomes for survival analysis were measured intraocular pressures < or =21 mmHg, with two or less topical medications.
Patients under 1 year old had trabeculotomy-trabeculectomy; the remainder had trabeculectomy alone. One case of primary congenital glaucoma had trabeculotomy-trabeculectomy at 24 months. Eighty-nine percent had previous failed glaucoma surgery. Twenty-five patients (33 eyes) had primary congenital glaucoma; 5 patients (5 eyes) had secondary glaucoma (aphakia or pseudophakia). Mean follow-up was 22.9 months (5.2-68.5). Sixty-six percent of all eyes had suture-release and 68% had bleb-needling (mean, 1.9 times). Five eyes (13%) needed further drainage tube surgery. Complications were early postoperative hypotony in three cases, requiring anterior chamber reinflation (mean age, 7.4 months at the time of surgery), two cases of transient wound leak, but no bleb-related complications or endophthalmitis. No blebs were avascular, or thin and cystic. Cumulative success was 75% for primary, but only 21% for secondary glaucoma at final follow-up.
Antimetabolite and releasable augmentation of filtration surgery appear to give favorable outcomes in the treatment of refractory primary pediatric glaucomas. Secondary glaucomas after cataract surgery do not show good long-term success. There were no major or sight-threatening complications in our series; no eyes developed cystic avascular blebs or bleb-related infections.
评估在儿童滤过性手术中使用可松解缝线、抗代谢药物以及用5-氟尿嘧啶（5FU）进行滤泡针刺术的效果。
对1999年至2004年间到一家三级儿科眼科中心就诊的30例（38只眼）儿童青光眼患者进行回顾性病例记录审查。采用小梁切除术或联合小梁切开术 - 小梁切除术，并使用抗代谢药物、可松解缝线和滤泡改良术。生存分析的成功结果定义为眼压≤21 mmHg，且使用两种或更少的局部用药。
1岁以下的患者接受小梁切开术 - 小梁切除术；其余患者仅接受小梁切除术。1例原发性先天性青光眼患者在24个月时接受了小梁切开术 - 小梁切除术。89%的患者既往青光眼手术失败。25例（33只眼）为原发性先天性青光眼；5例（5只眼）为继发性青光眼（无晶状体或人工晶状体眼）。平均随访时间为22.9个月（5.2 - 68.5个月）。所有眼中66%进行了缝线松解，68%进行了滤泡针刺术（平均1.9次）。5只眼（13%）需要进一步的引流管手术。并发症包括3例术后早期低眼压，需要前房再充盈（手术时平均年龄7.4个月），2例短暂性伤口渗漏，但无滤泡相关并发症或眼内炎。没有滤泡是无血管的，或薄且呈囊性。原发性青光眼最终随访时累积成功率为75%，但继发性青光眼仅为21%。
抗代谢药物和可松解缝线增强的滤过性手术在治疗难治性原发性儿童青光眼方面似乎能取得良好效果。白内障手术后的继发性青光眼未显示出良好的长期成功率。在我们的系列研究中没有严重或威胁视力的并发症；没有眼睛出现囊性无血管滤泡或滤泡相关感染。
