Mokbel Tharwat H, El Hefney Eman M, Hagras Sherein M, Badawi Amani E, Kasem Manal A, Al Nagdy Ahmed A, El Khouly Sherief E, Gaafar Walid M
Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.
Int J Ophthalmol. 2019 Feb 18;12(2):226-234. doi: 10.18240/ijo.2019.02.07. eCollection 2019.
To evaluate the outcome of the initial and the redo-surgeries for primary congenital glaucoma (PCG) correlated to its degree of severity.
A retrospective study involved patients with PCG presented between 2010 and 2018. Medical records were reviewed to assess the degree of the preoperative severity according to the intraocular pressure (IOP), corneal diameter and corneal edema. Success and failure rates were calculated for both first and redo-surgeries at 6 and 12mo respectively then correlated to the severity of the cases.
Complete records were retrieved for 272 eyes (153 patients) with PCG: 43 eyes were mild, 136 moderate and 93 severe. Combined trabeculotomy and trabeculectomy (CTT) had the highest success rate in moderate (96.4%) and severe cases (59.3%) while trabeculotomy had the highest success rate in mild cases (96.3%). Medical records of 88 eyes (63 patients) with recurrent PCG were analyzed, most with severe presentation (59 eyes). Ahmed glaucoma valve (AGV) was used in 67 (76%) eyes and augmented trabeculectomy in 21 (24%) eyes. At 12mo, there was no statistically significant difference between both surgeries in total success rate (=0.256). For mild cases, success rate was 100% for both surgeries. Severe cases had higher success rates following AGV (87%) than augmented trabeculectomy (20%). Preoperative severity of the disease was an independent factor affecting the failure rate in secondary trabeculectomy but not in AGV. Patients younger than 24mo had higher probabilities of failure following both redo-surgeries with hazard ratio=1.325 and 0.37 for augmented trabeculectomy and AGV respectively.
Preoperative assessment of the severity of eyes with PCG helps in the selecting the optimal primary and secondary surgery. For first surgery, trabeculotomy is more effective in mild cases whereas; CTT and augmented subscleral trabeculectomy (SST) are appropriate for moderate and severe cases. AGV proved to be superior to augmented SST in severe recurrent cases.
评估原发性先天性青光眼（PCG）初次手术和再次手术的结果与其严重程度的相关性。
一项回顾性研究纳入了2010年至2018年间就诊的PCG患者。查阅病历，根据眼压（IOP）、角膜直径和角膜水肿评估术前严重程度。分别计算初次手术和再次手术在6个月和12个月时的成功率和失败率，然后将其与病例的严重程度相关联。
检索到272只眼（153例患者）的完整病历，其中轻度43只眼，中度136只眼，重度93只眼。小梁切开术联合小梁切除术（CTT）在中度（96.4%）和重度病例（59.3%）中的成功率最高，而小梁切开术在轻度病例中的成功率最高（96.3%）。分析了88只眼（63例患者）复发性PCG的病历，大多数为重度表现（59只眼）。67只眼（76%）使用了艾哈迈德青光眼引流阀（AGV），21只眼（24%）采用了改良小梁切除术。在12个月时，两种手术的总成功率无统计学显著差异（P=0.256）。对于轻度病例，两种手术的成功率均为100%。重度病例中，AGV术后成功率（87%）高于改良小梁切除术（20%）。疾病的术前严重程度是影响二次小梁切除术失败率的独立因素，但对AGV手术无影响。年龄小于24个月的患者在两种再次手术术后失败的概率更高，改良小梁切除术和AGV的风险比分别为1.325和0.37。
对PCG患眼严重程度进行术前评估有助于选择最佳的初次和二次手术。对于初次手术，小梁切开术在轻度病例中更有效，而CTT和改良巩膜下小梁切除术（SST）适用于中度和重度病例。在重度复发性病例中，AGV被证明优于改良SST。
