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使用微导管的改良小梁切开术:我们在青光眼手术治疗中的技术与经验

Modified Viscotrabeculotomy with Microcatheter: Our Technique and Experience in the Surgical management of Glaucoma.

作者信息

Tamçelik Nevbahar, Capar Olgu, Atalay Eray

机构信息

Department of Ophthalmology, Istanbul University Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey.

Department of Ophthalmology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey.

出版信息

J Curr Glaucoma Pract. 2019 Sep-Dec;13(3):88-93. doi: 10.5005/jp-journals-10078-1263.

DOI:10.5005/jp-journals-10078-1263
PMID:32435120
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7221247/
Abstract

AIMS

To present the results of our case series with a technique we defined as "modified viscotrabeculotomy" which incorporates the benefits of 360° of trabeculotomy and viscodilation and viscodissection of canal of Schlemm using a microcatheter.

MATERIALS AND METHODS

This study was designed as a prospective interventional case series and was conducted in Cerrahpasa Medical School Ophthalmology Clinic. Forty-one eyes of 30 patients diagnosed with congenital glaucoma (CG) underwent modified viscotrabeculotomy surgery following initial preoperative examination. The main outcome measure was the surgical success of the procedure, which is determined by an intraocular pressure (IOP) of <18 mm Hg without medication or resurgery; qualified success is defined as an IOP of <18 mm Hg under general anesthesia with an additional need for medications. The differences in IOP measurements were analyzed using paired analysis of variance (ANOVA) with repeated measures.

RESULTS

The mean preoperative IOP of the patients was 32.27 ± 4.89 mm Hg. The IOP values at the 1st, 3rd, 6th postoperative months, and at the last visit were 13.41 ± 2.25 mm Hg, 13.70 ± 1.78 mm Hg, 12.47 ± 1.57 mm Hg, and 12.26 ± 1.81 mm Hg, respectively. The difference between the preoperative IOP values and postoperative IOP values was statistically significant ( < 0.001). The qualified surgical success rate was 94.4% after a mean follow-up of 27.95 ± 8.25 months (range 15-45 months).

CONCLUSION

Modified viscotrabeculotomy is a safe and effective treatment in the management of CG.

HOW TO CITE THIS ARTICLE

Tamçelik N, Capar O, Atalay E. Modified Viscotrabeculotomy with Microcatheter: Our Technique and Experience in the Surgical management of Glaucoma. J Curr Glaucoma Pract 2019;13(3):88-93.

摘要

目的

展示我们采用一种被定义为“改良粘小管切开术”的技术所得到的病例系列结果,该技术融合了360°小梁切开术以及使用微导管对施莱姆管进行粘弹扩张和粘弹分离的优点。

材料与方法

本研究设计为前瞻性干预性病例系列,在切拉帕萨医学院眼科诊所进行。30例诊断为先天性青光眼(CG)的患者的41只眼睛在进行初步术前检查后接受了改良粘小管切开术。主要观察指标是手术成功率,其定义为无需药物治疗或再次手术时眼压(IOP)<18 mmHg;合格成功定义为在全身麻醉下眼压<18 mmHg且额外需要药物治疗。使用重复测量的配对方差分析(ANOVA)分析眼压测量值的差异。

结果

患者术前平均眼压为32.27±4.89 mmHg。术后第1、3、6个月以及最后一次随访时的眼压值分别为13.41±2.25 mmHg、13.70±1.78 mmHg、12.47±1.57 mmHg和12.26±1.81 mmHg。术前眼压值与术后眼压值之间的差异具有统计学意义(<0.001)。平均随访27.95±8.25个月(范围15 - 45个月)后,合格手术成功率为94.4%。

结论

改良粘小管切开术是治疗先天性青光眼的一种安全有效的方法。

如何引用本文

Tamçelik N, Capar O, Atalay E. 微导管改良粘小管切开术:我们在青光眼手术治疗中的技术与经验。《当代青光眼实践杂志》2019;13(3):88 - 93。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1597/7221247/01244c20c670/jocgp-13-88-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1597/7221247/d49873a0d727/jocgp-13-88-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1597/7221247/74b5045cc542/jocgp-13-88-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1597/7221247/01244c20c670/jocgp-13-88-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1597/7221247/d49873a0d727/jocgp-13-88-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1597/7221247/74b5045cc542/jocgp-13-88-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1597/7221247/01244c20c670/jocgp-13-88-g003.jpg

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本文引用的文献

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Int J Ophthalmol. 2012;5(4):466-8. doi: 10.3980/j.issn.2222-3959.2012.04.11. Epub 2012 Aug 18.
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Surgical management of pediatric glaucoma.小儿青光眼的外科治疗
Dev Ophthalmol. 2012;50:157-72. doi: 10.1159/000334798. Epub 2012 Apr 17.
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The changing conceptual basis of trabeculectomy: a review of past and current surgical techniques.小梁切除术概念基础的变迁:对过去和当前手术技术的回顾。
Surv Ophthalmol. 2012 Jan-Feb;57(1):1-25. doi: 10.1016/j.survophthal.2011.07.005.
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Circumferential trabeculotomy with an illuminated microcatheter in congenital glaucomas.环形小梁切开术联合可发光微导管在先天性青光眼的应用。
J Glaucoma. 2012 Mar;21(3):160-3. doi: 10.1097/IJG.0b013e31822af350.
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An illuminated microcatheter for 360-degree trabeculotomy [corrected] in congenital glaucoma: a retrospective case series.用于先天性青光眼360度小梁切开术[校正后]的照明微导管:一项回顾性病例系列研究。
J AAPOS. 2010 Oct;14(5):412-6. doi: 10.1016/j.jaapos.2010.07.010.
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Long-term results of combined viscotrabeculotomy-trabeculectomy in refractory developmental glaucoma.联合黏小管切开术-小梁切除术治疗难治性发育性青光眼的长期疗效。
Eye (Lond). 2010 Apr;24(4):613-8. doi: 10.1038/eye.2009.185. Epub 2009 Sep 4.
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Use of viscoelastic substance in ophthalmic surgery - focus on sodium hyaluronate.眼科手术中粘弹性物质的应用——聚焦于透明质酸钠
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