Meirelles Sérgio Henrique Sampaio, Mathias Cristina Rodrigues, Bloise Renata Rianelli, Stohler Neire Sandra Flores, Liporaci Simone Duarte, Frota Ana Carolina, Simões Camila Cassiano
Hospital Municipal da Piedade daggerUniversidade Gama Filho, Rio de Janeiro, Brazil.
J Glaucoma. 2008 Sep;17(6):470-3. doi: 10.1097/IJG.0b013e3181650f6e.
To evaluate the change in optic disc cupping after surgical procedure for congenital glaucoma and assess the factors that may intervene on this process.
Prospective study involving 45 eyes of 36 patients with childhood glaucoma, who underwent surgical treatment at the Hospital Municipal da Piedade, Rio de Janeiro, Brazil, between January 1998 and December 2005. The study included patients <5 years old with intraocular pressure (IOP) <19 mm Hg for at least 6 months after surgery. Children who were > or =5 years old, IOP > or =19 mm Hg after surgery, and cloudy media were excluded from analysis. All patients were submitted a complete examination under narcosis before surgery and 1, 3, and 6 months after surgery. After this period, the follow-up was performed every 6 months until the study finished. To meet study criteria, vertical axis of the cup-to-disc ratio (C/D) was considered. The optic disc cupping was assessed independently before and after surgery by the same clinicians and the stabilization of the optic disc was confirmed in at least 2 consecutive tests. The variables evaluated with the reduction of the C/D were age at the time of the surgery, vertical axis of the optic disc cup, IOP and the horizontal corneal diameter preoperatively, quantity and type of surgical procedures performed, range of IOP reduction, number of antiglaucomatous drops taken postoperatively, and the type of glaucoma. The statistical methods were performed by the BioEstat 3.0 program.
There was a significant difference between the preoperative (0.75+/-0.15) and postoperative (0.62+/-0.22) C/D and the IOP measured preoperative (22.40+/-4.93 mm Hg) and postoperative (12.33+/-3.84 mm Hg). The variables that disclosed statistical significance were age at the time of surgery (P=0.008) and the reduction of the IOP after surgery (P=0.048). A higher reduction of cupping was observed in children < or =1 year old (0.18+/-0.12) at the time of the surgery.
Optic disc cupping can be reversed at an early stage of primary congenital glaucoma, especially before 1 year of age, after successful reduction of IOP by surgery.
评估先天性青光眼手术后视盘杯盘比的变化，并评估可能影响这一过程的因素。
对1998年1月至2005年12月期间在巴西里约热内卢市皮埃达德医院接受手术治疗的36例儿童青光眼患者的45只眼进行前瞻性研究。该研究纳入术后眼压（IOP）<19 mmHg且持续至少6个月的5岁以下患者。排除术后年龄≥5岁、IOP≥19 mmHg以及屈光间质混浊的儿童。所有患者在手术前、术后1、3和6个月接受了一次全身麻醉下的全面检查。在此之后，每6个月进行一次随访，直至研究结束。为符合研究标准，采用视杯与视盘垂直径比（C/D）。视盘杯盘比由同一名临床医生在手术前后独立评估，且至少连续2次检查确认视盘稳定。评估与C/D降低相关的变量包括手术时年龄、视盘杯垂直径、术前IOP和角膜水平直径、手术方式及数量、IOP降低幅度、术后抗青光眼滴眼液使用数量以及青光眼类型。采用BioEstat 3.0软件进行统计分析。
术前（0.75±0.15）与术后（0.62±0.22）C/D以及术前（22.40±4.93 mmHg）与术后（12.33±3.84 mmHg）测量的IOP之间存在显著差异。具有统计学意义的变量为手术时年龄（P = 0.008）和术后IOP降低（P = 0.048）。手术时年龄≤1岁的儿童杯盘比降低更为明显（0.18±0.12）。
在原发性先天性青光眼早期，尤其是1岁前，通过手术成功降低眼压后，视盘杯盘比可逆转。
