坦桑尼亚北部儿童原发性青光眼手术干预的结果

Outcomes of surgical interventions for primary childhood glaucoma in Northern Tanzania.

作者信息

Fieß Achim, Furahini Godfrey, Bowman Richard, Bauer Jacqueline, Dithmar Stefan, Philippin Heiko

机构信息

Department of Ophthalmology, HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany.

Department of Ophthalmology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.

出版信息

Br J Ophthalmol. 2017 Feb;101(2):126-130. doi: 10.1136/bjophthalmol-2015-308137. Epub 2016 Apr 20.

DOI:10.1136/bjophthalmol-2015-308137

PMID:27098747

Abstract

AIM

To evaluate goniotomy, trabeculotomy, transscleral cyclophotocoagulation (TSCPC) and trabeculectomy as initial procedures in children with primary childhood glaucoma from Northern Tanzania.

METHODS

A retrospective analysis of consecutive interventions for primary childhood glaucoma from 2000 to 2013 was conducted at the Kilimanjaro Christian Medical Centre. Success was defined as postoperative intraocular pressure (IOP) below 22 mmHg. Success rates, IOP, visual acuity (VA), subsequent interventions and potential risk factors for failure were reported for the respective interventions.

RESULTS

The study included 116 eyes of 70 children (age 4.6±5.9 years) with primary childhood glaucoma; 46 (65.7%) children were male. The preoperative IOP was 33.1±10.2 mmHg, the preoperative cup/disc (CD) ratio 0.71±0.3 and the corneal diameter 13.3±1.4 mm. As a primary intervention, 61 (52.6%) eyes underwent goniotomy, 10 (8.6%) eyes trabeculotomy, 12 (10.3%) TSCPC and 33 (28.4%) trabeculectomy. Follow-up data after 12 months were available for 63 (54.3%) eyes. Success rates at 12 months were 38% (goniotomy), 30% (trabeculotomy), 17% (TSCPC) and 64% (trabeculectomy). All interventions achieved a statistically significant IOP reduction at 3, 6 and 12 months, except for trabeculotomy after 6 months and TSCPC at all time points. Postoperative endophthalmitis occurred in one child treated with trabeculectomy. VA in 82% of all eyes was maintained or had improved after 12 months.

CONCLUSIONS

Based on the success rates of this retrospective analysis, goniotomy or trabeculotomy for younger and trabeculectomy for older children can be recommended in our setting to reduce IOP. Late presentation in combination with advanced glaucomatous damage as well as erratic postoperative follow-up and treatment were likely factors that compromised overall success rates. More efforts are necessary to detect the blinding disease earlier and improve adherence to follow-up.

摘要

目的

评估前房角切开术、小梁切开术、经巩膜睫状体光凝术（TSCPC）和小梁切除术作为坦桑尼亚北部原发性儿童青光眼患儿的初始治疗方法。

方法

在乞力马扎罗基督教医疗中心对2000年至2013年期间连续进行的原发性儿童青光眼干预措施进行回顾性分析。成功定义为术后眼压（IOP）低于22 mmHg。报告了各干预措施的成功率、眼压、视力（VA）、后续干预措施以及失败的潜在危险因素。

结果

该研究纳入了70例（年龄4.6±5.9 岁）原发性儿童青光眼患儿的116只眼；46例（65.7%）为男性。术前眼压为33.1±10.2 mmHg，术前杯盘（CD）比为0.71±0.3，角膜直径为13.3±1.4 mm。作为初始干预措施，61只眼（52.6%）接受了前房角切开术，10只眼（8.6%）接受了小梁切开术，12只眼（10.3%）接受了TSCPC，33只眼（28.4%）接受了小梁切除术。63只眼（54.3%）有12个月后的随访数据。12个月时的成功率分别为：前房角切开术38%，小梁切开术30%，TSCPC 17%，小梁切除术64%。除小梁切开术在6个月后以及TSCPC在所有时间点外，所有干预措施在3个月、6个月和12个月时眼压均有统计学意义的降低。接受小梁切除术治疗的1例患儿发生了术后眼内炎。12个月后，82%的患眼视力得以维持或提高。