Ophthalmology Department, Faculty of Medicine, Menofia University, Shebin El Kom, Egypt.
Int Ophthalmol. 2020 Oct;40(10):2699-2706. doi: 10.1007/s10792-020-01453-x. Epub 2020 Jun 1.
This prospective study aimed to compare the surgical outcomes of ab externo 240-degree trabeculotomy and trabeculotomy-trabeculectomy in managing primary congenital glaucoma (PCG).
The study included 30 eyes of 30 patients aged less than 3 years who were diagnosed with PCG and was conducted in Menofia University Hospital between November 2018 and January 2020. The studied eyes were divided into two equal groups. Ab externo 240-degree trabeculotomy and combined trabeculotomy with trabeculectomy with MMC were performed for groups I and II, respectively. Post-operative measurements included intraocular pressure (IOP), optic disc changes, alteration in corneal clarity and transverse corneal diameter, as they are needed for antiglaucoma therapy. Post-operative complications were followed up for 1-year.
There was significant reduction in IOP in both groups during the follow-up period. The reduction was higher in group I, where mean preoperative IOP was 28.20 ± 1.74 mmHg. The IOP in the group II was 28.07 ± 3.51 mmHg. The mean IOP decreased to 13.93 ± 1.8 mmHg and 14.60 ± 1.24 mmHg in groups I and II, respectively, after 1 year (P < 0.001); however, the difference between the two groups was not significant. Regarding post-operative complications, post-operative hypotony was more common in group I. Other complications such as shallow anterior chamber, choroidal detachment and blebitis occurred more frequently in group II. However, post-operative hyphema was more common in group I. Corneal clarity improved significantly in both groups, but more so in group I, where an improvement was seen in 13 cases (86.6%), compared to 11 cases in group II (73.3%).
Ab externo 240° trabeculotomy and trabeculotomy-trabeculectomy are effective techniques in primary congenital glaucoma with more reduction in IOP in Ab Externo 240° trabeculotomy. Ab externo 240° trabeculotomy provided more better surgical outcome with limited complications, especially those related to bleb formation.
本前瞻性研究旨在比较外路 240 度小梁切开术和小梁切开联合小梁切除术治疗原发性先天性青光眼（PCG）的手术效果。
该研究纳入了 2018 年 11 月至 2020 年 1 月在 Menofia 大学医院就诊的年龄小于 3 岁的 30 例（30 只眼）PCG 患者。将研究眼分为两组，一组行外路 240 度小梁切开术（I 组），另一组行小梁切开联合小梁切除术联合丝裂霉素 C（MMC）（II 组）。术后测量眼压（IOP）、视盘变化、角膜透明度变化和横向角膜直径，以便进行青光眼治疗。术后随访 1 年观察并发症。
两组患者的 IOP 在随访期间均显著降低。I 组的降幅更大，术前平均 IOP 为 28.20±1.74mmHg，术后 IOP 为 13.93±1.8mmHg。II 组术前平均 IOP 为 28.07±3.51mmHg，术后 IOP 为 14.60±1.24mmHg，两组间差异无统计学意义（P<0.001）。术后并发症方面，I 组术后发生低眼压的比例较高，II 组术后发生浅前房、脉络膜脱离和眼内炎的比例较高。但 I 组术后发生前房积血的比例较高。两组患者的角膜透明度均显著改善，但 I 组改善更明显，13 例（86.6%）患者的角膜透明度得到改善，而 II 组仅 11 例（73.3%）患者的角膜透明度得到改善。
外路 240 度小梁切开术和小梁切开联合小梁切除术是治疗原发性先天性青光眼的有效方法，外路 240 度小梁切开术可更有效降低眼压。外路 240 度小梁切开术的手术效果更好，并发症更少，尤其是与滤过泡形成相关的并发症更少。
