Zagora Sophia L, Funnell Charlotte L, Martin Frank J, Smith James E H, Hing Stephen, Billson Francis A, Veillard Anne-Sophie, Jamieson Robyn V, Grigg John R
Discipline of Ophthalmology, University of Sydney, Sydney, NSW, Australia.
Department of Ophthalmology, The Children's Hospital at Westmead, Sydney, NSW, Australia; Epsom and St Helier University Hospitals, National Hospital Service Trust, London, United Kingdom.
Am J Ophthalmol. 2015 Apr;159(4):788-96. doi: 10.1016/j.ajo.2015.01.019. Epub 2015 Jan 26.
To determine in primary congenital glaucoma whether age of presentation influences surgical success, the degrees of angle surgery needed to achieve glaucoma control, and whether there are critical ages where glaucoma progresses, requiring further surgical management.
Retrospective cohort study.
The medical records of patients with primary congenital glaucoma over a 23-year period were reviewed: 192 procedures were performed on 117 eyes (70 patients). The number and age of angle procedures and final visual acuity was analyzed. Surgical success was defined as stable intraocular pressure and optic disc appearance.
Procedures involving 83 of the 110 eyes (75.5%) undergoing angle surgery were successful, with 2-, 4-, 6-, and 10-year success rates of 92%, 86%, 84%, and 75%, respectively. Subgroup analysis (<3 months; 3-6 months; >6 months) comparing age of diagnosis to visual outcome (<20/200, 20/200-20/40, >20/40) was significant (P = .04). The age at first operation (P = .94), the number of angle operations (P = .43), and their effect on angle surgery success was not significant. Seven of 192 operations were performed after the age of 8 years (3.6%). After the initial angle surgeries within the first year of life, the third procedure occurred at a median age of 2.4 years (interquartile ratio [IQR] 0.6-3.8 years) and the fourth procedure occurred at a median age of 5.3 years (IQR 2.5-6.1 years).
Children diagnosed at <3 months of age had a visual outcome of <20/200 despite successful glaucoma control. Age of presentation did not affect surgical success. A total of 78.9% of cases undergoing primary trabeculotomy were controlled with 1 operation: 4 clock hours of angle (120 degrees). Analysis of glaucoma progression suggests critical ages where further glaucoma surgery is required at around 2 and 5 years of age.
确定在原发性先天性青光眼中，发病年龄是否会影响手术成功率、控制青光眼所需的房角手术程度，以及是否存在青光眼进展的关键年龄，从而需要进一步的手术治疗。
回顾性队列研究。
回顾了23年间原发性先天性青光眼患者的病历：对117只眼（70例患者）进行了192次手术。分析了房角手术的次数和年龄以及最终视力。手术成功定义为眼压稳定和视盘外观正常。
接受房角手术的110只眼中，83只眼（75.5%）的手术成功，2年、4年、6年和10年的成功率分别为92%、86%、84%和75%。将诊断年龄与视力结果（<20/200、20/200 - 20/40、>20/40）进行亚组分析（<3个月；3 - 6个月；>6个月）具有显著性（P = 0.04）。首次手术年龄（P = 0.94）、房角手术次数（P = 0.43）及其对房角手术成功率的影响不显著。192次手术中有7次在8岁以后进行（3.6%）。在生命的第一年进行初次房角手术后，第三次手术的中位年龄为2.4岁（四分位间距[IQR] 0.6 - 3.8岁），第四次手术的中位年龄为5.3岁（IQR 2.5 - 6.1岁）。
尽管青光眼得到成功控制，但在3个月龄前被诊断出的儿童视力结果仍<20/200。发病年龄不影响手术成功率。总共78.9%接受原发性小梁切开术的病例通过1次手术得到控制：4个钟点的房角（120度）。青光眼进展分析表明，在2岁和5岁左右存在需要进一步进行青光眼手术的关键年龄。
