Ophthalmology Department, Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Eur J Ophthalmol. 2021 Mar;31(2):786-795. doi: 10.1177/1120672120922453. Epub 2020 May 26.
To assess the long-term results of viscotrabeculotomy in infants with primary congenital glaucoma and to compare its outcome with conventional trabeculotomy.
A prospective randomized comparative study included infants with primary congenital glaucoma younger than 2 years. Patients were divided into two groups: viscotrabeculotomy group and conventional trabeculotomy group. Preoperative and postoperative intraocular pressures, corneal diameter, intraoperative and postoperative complications, and success rates were compared between two groups. All the patients were followed up for 5 years.
The study included 154 eyes of 92 infants distributed randomly among the two groups; 78 and 76 eyes in viscotrabeculotomy and conventional trabeculotomy groups, respectively. In both groups, there was a statistically significant intraocular pressure reduction at all time points of the follow-up periods compared to the preoperative values (p < 0.0001). At 5 years, viscotrabeculotomy group showed significant reduction of the mean postoperative intraocular pressure (49.47%) than conventional trabeculotomy group (48.64%) (p < 0.0001). Intraocular pressure was statistically lower in viscotrabeculotomy starting from 12th month and till the end of the follow-up. At 5 years, the total success rate of viscotrabeculotomy group was 89.74% compared to 85.53% in conventional trabeculotomy group without significant difference (p = 0.487). The postoperative mean values of the cup/disk ratio in viscotrabeculotomy group showed statistically lower values compared to conventional trabeculotomy group (p = 0.019). Postoperative hyphema was statistically higher in conventional trabeculotomy group (p < 0.0001). All eyes that underwent a reoperation before 5 years follow-up were excluded from the statistical workup of the study after reoperation, except for calculation of success/failure.
Viscotrabeculotomy and conventional trabeculotomy proved to be effective in cases of primary congenital glaucoma. Viscotrabeculotomy appeared to have prolonged stability in controlling the intraocular pressure with higher success rates and lower complications.
评估黏小管切开术治疗婴幼儿先天性青光眼的长期疗效，并将其结果与传统小梁切开术进行比较。
前瞻性随机对照研究纳入年龄小于 2 岁的先天性青光眼婴幼儿患者。患者分为两组：黏小管切开术组和传统小梁切开术组。比较两组患者术前、术后眼压、角膜直径、术中及术后并发症及成功率。所有患者均随访 5 年。
本研究共纳入 92 例婴幼儿的 154 只眼，随机分为两组；黏小管切开术组和传统小梁切开术组分别为 78 只眼和 76 只眼。两组患者在随访期间的所有时间点与术前相比，眼压均有统计学意义的降低（p<0.0001）。5 年时，黏小管切开术组术后平均眼压下降（49.47%）明显大于传统小梁切开术组（48.64%）（p<0.0001）。黏小管切开术组从第 12 个月开始，直至随访结束，眼压均有统计学意义的降低。5 年时，黏小管切开术组总成功率为 89.74%，传统小梁切开术组为 85.53%，差异无统计学意义（p=0.487）。黏小管切开术组术后杯盘比的平均值明显低于传统小梁切开术组（p=0.019）。传统小梁切开术组术后发生血影细胞的概率明显更高（p<0.0001）。所有在 5 年随访前接受再次手术的患者在再次手术后均被排除在研究的统计学分析之外，除外对成功率/失败率的计算。
黏小管切开术和传统小梁切开术对婴幼儿先天性青光眼均有效。黏小管切开术在控制眼压方面表现出更高的成功率和更低的并发症，且眼压稳定性更持久。
