小梁切除术或经巩膜睫状体光凝术作为坦桑尼亚北部儿童继发性青光眼的初始治疗方法
Trabeculectomy or Transscleral Cyclophotocoagulation as Initial Treatment of Secondary Childhood Glaucoma in Northern Tanzania.
作者信息
Fieß Achim, Shah Peter, Sii Freda, Godfrey Furahini, Abbott Joe, Bowman Richard, Bauer Jacqueline, Dithmar Stefan, Philippin Heiko
机构信息
*Department of Ophthalmology ††Paediatric Department, HELIOS Dr. Horst Schmidt Klinik, Wiesbaden, Germany †Department of Ophthalmology ∥Birmingham Institute for Glaucoma Research, Institute for Translational Medicine, University Hospitals Birmingham NHS Foundation Trust **Birmingham Children's Hospital NHS Foundation Trust, Birmingham ‡University College London, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology #International Centre for Eye Health, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London §Centre for Health & Social Care Improvement, Faculty of Education Health & Wellbeing, University of Wolverhampton, Wolverhampton, UK ¶Department of Ophthalmology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
出版信息
J Glaucoma. 2017 Jul;26(7):657-660. doi: 10.1097/IJG.0000000000000682.
PURPOSE
The purpose is to describe the outcome of trabeculectomy with transscleral cyclophotocoagulation (TSCPC) as an initial intervention for secondary childhood glaucoma in Northern Tanzania.
METHODS
A retrospective, consecutive case series was analyzed of all children with secondary childhood glaucoma who underwent initial trabeculectomy or TSCPC between 2000 and 2013 at a referral eye unit in Northern Tanzania. Retrospective data were collected on causes of glaucoma, intraocular pressure (IOP), visual acuity, complications, and subsequent interventions. Outcomes were evaluated using Kaplan-Meier survival analysis and compared with Cox regression analysis. The main outcome measure was failure (IOP>21 mm Hg).
RESULTS
Thirty-six eyes of 27 children (male, 21; median age, 9 y; range, 0.3 to 15 y) with secondary childhood glaucoma underwent trabeculectomy (19 eyes, 53%) or TSCPC (17 eyes, 47%). Causes included ocular trauma (13, 36%), previous cataract surgery (12, 33%), congenital aniridia (5, 14%), Sturge-Weber syndrome (2, 6%), steroid-induced glaucoma (2, 6%), uveitis (1, 3%), and unspecified leucoma (1, 3%). After 12 months, success was achieved in 48% after trabeculectomy and 18% after TSCPC, with visual acuity remaining unchanged in 11 of 14 (79%) and 4 of 5 eyes (80%), respectively. One third of the children did not return for follow-up after 1 year. Distance to the hospital (>100 km) was a significant risk factor for trabeculectomy failure (P=0.031).
CONCLUSIONS
A high proportion of secondary childhood glaucoma in Northern Tanzania was caused by trauma and previous cataract surgery. Trabeculectomy was associated with better IOP control but also a higher complication rate. The ability to maintain visual function was comparable after both interventions. Failure was associated with a journey to the eye hospital (>100 km) possibly leading to late presentation with advanced disease and erratic follow-up.
目的
描述小梁切除术联合经巩膜睫状体光凝术（TSCPC）作为坦桑尼亚北部儿童继发性青光眼初始干预措施的治疗效果。
方法
对2000年至2013年间在坦桑尼亚北部一家转诊眼科单位接受初始小梁切除术或TSCPC的所有儿童继发性青光眼患者进行回顾性连续病例系列分析。收集有关青光眼病因、眼压（IOP）、视力、并发症及后续干预措施的回顾性数据。采用Kaplan-Meier生存分析评估治疗效果，并与Cox回归分析进行比较。主要观察指标为治疗失败（眼压>21 mmHg）。
结果
27例儿童（男21例；中位年龄9岁；范围0.3至15岁）的36只继发性儿童青光眼患眼接受了小梁切除术（19只眼，53%）或TSCPC（17只眼，47%）。病因包括眼外伤（13例，36%）、既往白内障手术（12例，33%）、先天性无虹膜（5例，14%）、斯-韦综合征（2例，6%）、类固醇性青光眼（2例，6%）、葡萄膜炎（1例，3%）和未明确的角膜白斑（1例，3%）。12个月后，小梁切除术后48%的患者治疗成功，TSCPC术后18%的患者治疗成功，14只眼中的11只（79%）和5只眼中的4只（80%）视力分别保持不变。三分之一的儿童在1年后未返回进行随访。距离医院较远（>100公里）是小梁切除术失败的一个重要危险因素（P = 0.031）。
结论
坦桑尼亚北部儿童继发性青光眼的很大一部分是由外伤和既往白内障手术引起的。小梁切除术与更好的眼压控制相关，但并发症发生率也更高。两种干预措施后维持视觉功能的能力相当。治疗失败与前往眼科医院的路程较远（>100公里）有关，这可能导致疾病晚期就诊和随访不规律。
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