Glaucoma Clinic New Delhi, New Delhi India.
SK Glaucoma Care Foundation, New Delhi India.
Eye (Lond). 2018 Feb;32(2):426-432. doi: 10.1038/eye.2017.207. Epub 2017 Oct 6.
PurposeAssess long-term outcome of combined trabeculotomy-trabeculectomy (CTT) in primary congenital glaucoma (PCG).MethodsData of PCG patients treated with CTT by a single surgeon between 1976 and 1993 were reviewed for reduction in intraocular pressure (IOP), visual acuities, surgical success rates, and need for repeat surgeries at last follow-up (FU). At the last FU, IOP<21 mm Hg without any topical antiglaucoma medication (TAM) was complete success and with 1-2 TAMs was qualified success. IOP reduction ≥30% without any TAM was modified complete success and with 1-2 TAMs was modified qualified success. IOP>21 mm Hg, IOP reduction <30%, or use of >2 TAM at last FU, or need for additional surgery was considered as failure.ResultsTwo hundred thirty eyes of 121 patients had been followed up for 21.5-38 years (mean 28.87±2.77 years). Eyes that were pthisical (3), had immeasurable IOP (2), or IOP<6 mm Hg (3) were excluded from the success analysis. At last FU, mean IOP reduction was 22.71±11.28 mm Hg and TAM score was 1.71 (0-4). Complete success was achieved in 14 (6.3%), modified complete success in 14 (6.3%), qualified success in 148 (66.7%), and modified qualified success in 140 (63.1%). Success probability was 95% till 25 years and 92, 90, 85, 79 and 68% at 26, 27, 28, 29, and 30 years, respectively. Severe visual impairment or functional blindness was found in only 13 (10.7%) patients.ConclusionCTT shows long-term success in PCG patients. All patients must be monitored for IOP control to avoid need for repeat surgeries.
目的评估原发性先天性青光眼（PCG）患者联合小梁切开术-小梁切除术（CTT）的长期疗效。
方法回顾性分析 1976 年至 1993 年间由同一位外科医生行 CTT 治疗的 PCG 患者的临床资料，包括眼压（IOP）降低、视力、手术成功率以及末次随访（FU）时是否需要再次手术。末次 FU 时，无需任何局部抗青光眼药物（TAM）眼压<21mmHg 为完全成功，使用 1-2 种 TAMs 为合格成功。眼压降低≥30%而无需任何 TAMs 为改良完全成功，使用 1-2 种 TAMs 为改良合格成功。末次 FU 时眼压>21mmHg、眼压降低<30%、或使用>2 种 TAMs 或需要再次手术则认为手术失败。
结果121 例患者的 230 只眼接受了 21.5-38 年（平均 28.87±2.77 年）的随访。对已萎缩（3 只眼）、IOP 无法测量（2 只眼）或 IOP<6mmHg（3 只眼）的眼排除在成功分析之外。末次 FU 时，平均眼压降低 22.71±11.28mmHg，TAM 评分为 1.71（0-4）。14 只眼（6.3%）获得完全成功，14 只眼（6.3%）获得改良完全成功，148 只眼（66.7%）获得合格成功，140 只眼（63.1%）获得改良合格成功。25 年内成功率为 95%，26、27、28、29 和 30 年时成功率分别为 92%、90%、85%、79%和 68%。仅 13 例（10.7%）患者视力严重受损或失明。
结论CTT 治疗 PCG 患者可获得长期疗效。所有患者均需监测眼压控制情况，以避免需要再次手术。
