从传统角度手术到小儿青光眼的 360 度小梁切开术。

From Conventional Angle Surgery to 360-Degree Trabeculotomy in Pediatric Glaucoma.

机构信息

Glaucoma Department, Moorfields Eye Hospital, London, United Kingdom.

Glaucoma Department, Moorfields Eye Hospital, London, United Kingdom; Department of Ophthalmology, Autonomous University of Nuevo Leon, Monterrey, Nuevo León, Mexico.

出版信息

Am J Ophthalmol. 2020 Nov;219:77-86. doi: 10.1016/j.ajo.2020.06.017. Epub 2020 Jun 20.

DOI:10.1016/j.ajo.2020.06.017

PMID:32569736

Abstract

PURPOSE

To describe the transition from conventional angle surgery (CAS), trabeculotomy with rigid probe or goniotomy, to 360-degree trabeculotomy assisted with microcatheter (MCT).

DESIGN

Retrospective comparative interventional case series.

METHODS

Review of consecutive children with glaucoma undergoing angle surgery, including cases with previous surgery, from January 2012 until March 2018 at Moorfields Eye Hospital. Main outcome measure was success rate, defined as intraocular pressure (IOP) ≤21 mm Hg with a minimum of 20% of IOP reduction and no further glaucoma surgery (complete success: without the need of glaucoma drops; qualified success: drops were needed to keep the IOP under control).

RESULTS

Among the 106 eyes (77 patients) included were 54 MCT and 52 CAS eyes. At last visit, after a single surgery, qualified success was 85% (46 eyes) in MCT and 37% (19 eyes) in CAS. Complete success was 69% (37 cases) in MCT and 23% (12 cases) in CAS. The mean (95% confidence interval) change in axial length after surgery was -0.03 mm (-0.34 to 0.40) for MCT and +1.35 mm (-0.64 to 1.62) for CAS (P < .001). The percentage of IOP reduction was 52.1% in MCT and 45.5% in CAS (P = .1616). Further glaucoma surgery was required in 5.5% (3) in MCT and 63.4% (33) in CAS. At 1 year, 94.3% of MCT cases achieved qualified success compared to 34.6% of CAS (P < .0001). No significant complications were found on either group.

CONCLUSION

MCT achieved better results with significantly lower reoperation rates. The transition from CAS to MCT can be easily achieved, even in difficult cases or those previously operated.

摘要

目的

描述从传统巩膜角切开术（CAS）、刚性探针或前房角切开术到 360 度巩膜角切开术联合微导管（MCT）的转变。

设计

回顾性对比介入性病例系列。

方法

回顾 2012 年 1 月至 2018 年 3 月在莫尔菲尔德眼科医院接受角手术的连续青光眼儿童患者，包括既往手术病例。主要观察指标为成功率，定义为眼压（IOP）≤21mmHg，IOP 降低至少 20%，且无需进一步青光眼手术（完全成功：无需使用降眼压药；合格成功：需要滴降眼压药控制眼压）。

结果

共纳入 106 只眼（77 例），其中 54 只眼行 MCT，52 只眼行 CAS。末次随访时，单次手术后，MCT 组有 85%（46 只眼）和 CAS 组有 37%（19 只眼）获得合格成功。MCT 组完全成功率为 69%（37 例），CAS 组为 23%（12 例）。手术后眼轴平均（95%置信区间）变化，MCT 组为-0.03mm（-0.34 至 0.40），CAS 组为+1.35mm（-0.64 至 1.62）（P<0.001）。MCT 组 IOP 降低率为 52.1%，CAS 组为 45.5%（P=0.1616）。MCT 组需要进一步青光眼手术的比例为 5.5%（3 例），CAS 组为 63.4%（33 例）。术后 1 年，MCT 组有 94.3%获得合格成功，而 CAS 组仅为 34.6%（P<0.0001）。两组均未发现明显并发症。