Wu Yue, Yu Rujing, Chen Di, Xu Li, Zhu Li, Li Mao, Guo Chunyu, Gu Ping, Lin Xiaoxi, Guo Wenyi
Department of Ophthalmology, Ninth People's Hospital Affiliated With Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Plastic and Reconstructive Surgery, Ninth People's Hospital Affiliated With Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Am J Ophthalmol. 2017 Oct;182:141-146. doi: 10.1016/j.ajo.2017.08.002. Epub 2017 Aug 12.
To evaluate the intermediate-term efficacy and safety of trabeculotomy in infant Sturge-Weber syndrome (SWS).
Retrospective cohort study.
All SWS-induced glaucoma patients less than 12 months of age who underwent trabeculotomy at our Ophthalmology Department from August 2011 to March 2017 were reviewed. Baseline demographics, intraocular pressure (IOP), cup-to-disc ratio (C/D), and cornea diameters were noted before surgery. The IOP, success probabilities, and medication usage were recorded during follow-up until the last visit.
Overall, 34 eyes (32 patients) were included, with a median surgery age of 3 months and a median follow-up time of 15.5 months. The mean preoperative IOP, asymmetry between 2 eyes, cornea diameter, and median C/D were 21.5 ± 6.6 mm Hg, 10.1 ± 4.9 mm Hg, 12.6 ± 0.7 mm, and 0.65 (interquartile range [IQR]: 0.55, 0.80), respectively. The IOP was significantly reduced from the preoperative baseline at 1 week, 3 months, 6 months, 1 year, and 2 years after the surgery (P < .05). At the last follow-up, the cumulative proportions of overall and complete success were 86.6% and 66.0%, respectively. Complications included a transient shallow anterior chamber. Thirty of the 34 eyes had intraoperative hyphema, 27 of which lasted less than 3 days. No other complications were noted during the follow-up.
Compared to previous studies with a later diagnosis of glaucoma in SWS patients, better outcomes were achieved with an early diagnosis of glaucoma in SWS patients. Early trabeculotomy ab externo was safe and led to good intermediate-term surgical outcomes for early-onset glaucoma in SWS patients. Higher preoperative IOP and corneal edema were associated with a greater risk of surgery failure.
评估小梁切开术治疗婴儿型斯特奇-韦伯综合征（SWS）的中期疗效和安全性。
回顾性队列研究。
对2011年8月至2017年3月在我院眼科接受小梁切开术的所有年龄小于12个月的SWS相关性青光眼患者进行回顾性分析。记录手术前的基线人口统计学资料、眼压（IOP）、杯盘比（C/D）和角膜直径。随访期间直至最后一次就诊时记录眼压、成功概率和药物使用情况。
共纳入34只眼（32例患者），手术年龄中位数为3个月，随访时间中位数为15.5个月。术前平均眼压、双眼眼压不对称性、角膜直径和C/D中位数分别为21.5±6.6mmHg、10.1±4.9mmHg、12.6±0.7mm和0.65（四分位数间距[IQR]：0.55，0.80）。术后1周、3个月、6个月、1年和2年时眼压较术前基线水平显著降低（P<0.05）。在最后一次随访时，总体成功和完全成功的累积比例分别为86.6%和66.0%。并发症包括短暂性浅前房。34只眼中有30只眼术中出现前房积血，其中27只持续时间不到3天。随访期间未发现其他并发症。
与既往对SWS患者青光眼诊断较晚的研究相比，SWS患者青光眼早期诊断可取得更好的结果。早期外路小梁切开术安全，可为SWS患者早发性青光眼带来良好的中期手术效果。术前眼压较高和角膜水肿与手术失败风险较大相关。
