Department of Ophthalmology, University Medical Center Mainz, Mainz.
Department of Ophthalmology, Alexandrovska University Hospital, Sofia, Bulgaria.
J Glaucoma. 2018 Jul;27(7):572-577. doi: 10.1097/IJG.0000000000000966.
To determine feasibility, efficacy, and safety of ab externo 360-degree trabeculotomy with illuminated microcatheter for congenital glaucoma.
The postoperative results of 36 eyes in 23 consecutive patients who underwent 360-degree trabeculotomy for primary congenital glaucoma (PCG) or secondary congenital glaucoma using an illuminated microcatheter were retrospectively analyzed. Success criteria were defined as intraocular pressure (IOP) ≤18 mm Hg without (complete success) and with medication (qualified success).
In all previously nonoperated eyes with PCG (group 1), the Schlemm's canal was identified and circumferentially cannulated for 360-degree trabeculotomy. In group 2 comprising of operated eyes with PCG and eyes with secondary congenital glaucoma, the performance of 360-degree trabeculotomy failed in 4 eyes because of the Schlemm's canal occlusion or high tissue resistance of the trabecular meshwork. Mean preoperative IOP was 28.6±5 and 29.6±9 mm Hg with 7 of 20 eyes and 7 of 9 eyes receiving IOP-lowering medication in group 1 and group 2, respectively. Mean postoperative IOP was reduced to 13±2.7 and 20.2±7.1 mm Hg after a mean follow-up of 15.3 and 12.7 months with 4 of 20 eyes and 5 of 9 eyes receiving medication in group 1 and group 2, respectively. Four eyes underwent further surgery. Complete success was achieved in 16 and 3 eyes, whereas qualified success was achieved in 20 and 4 eyes from group 1 and group 2, respectively. In all eyes, a mild to moderate postoperative hyphema was observed.
Ab externo catheter-assisted 360-degree trabeculotomy controls IOP in a majority of patients with congenital glaucoma after a single operation. Moderate blood reflux in the anterior chamber is considered as a common postoperative finding. We did not observe hypotony or other severe complications in our series. In 1 patient, we experienced catheter misdirection in an eye that had previously undergone trabeculotomy.
确定使用带照明微导管的外路 360 度小梁切开术治疗先天性青光眼的可行性、疗效和安全性。
回顾性分析 23 例连续患者 36 只眼接受带照明微导管的 360 度小梁切开术治疗原发性先天性青光眼（PCG）或继发性先天性青光眼的术后结果。成功标准定义为眼压（IOP）≤18mmHg 且无需（完全成功）和需要药物治疗（合格成功）。
在所有以前未接受手术的 PCG 患者（第 1 组）中，均识别并环形穿刺 Schlemm 管进行 360 度小梁切开术。在包括第 1 组已手术 PCG 眼和继发性先天性青光眼眼的第 2 组中，由于 Schlemm 管闭塞或小梁网组织阻力高，4 只眼的 360 度小梁切开术失败。第 1 组和第 2 组的 20 只眼中有 7 只和 9 只眼中的 7 只眼术前平均眼压分别为 28.6±5mmHg 和 29.6±9mmHg，分别接受 7 只和 9 只眼降压药物治疗。第 1 组和第 2 组的 20 只眼和 9 只眼的平均术后眼压分别在平均随访 15.3 个月和 12.7 个月后降至 13±2.7mmHg 和 20.2±7.1mmHg，分别有 4 只眼和 5 只眼接受药物治疗。4 只眼进一步手术。第 1 组和第 2 组分别有 16 只眼和 3 只眼完全成功，20 只眼和 4 只眼合格成功。所有眼均观察到轻至中度术后前房积血。
外路导管辅助 360 度小梁切开术可在单次手术后控制大多数先天性青光眼患者的眼压。前房中等程度血液反流被认为是一种常见的术后发现。在我们的系列中，我们没有观察到低眼压或其他严重并发症。在 1 例患者中，我们在先前接受过小梁切开术的眼出现了导管错位。
