Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society.
Department of Ophthalmology, Suddhavej Hospital, Mahasarakham University, Mahasarakham, Thailand.
J Glaucoma. 2022 Apr 1;31(4):274-279. doi: 10.1097/IJG.0000000000001980.
The aim was to report long-term surgical success of primary congenital glaucoma (PCG) patients in Thailand.
PCG patients who underwent one of the following primary operations: trabeculotomy, goniotomy, trabeculectomy, combined trabeculotrabeculectomy (CTT) and diode transscleral cyclophotocoagulation (TSCPC) between January 1992 and January 2018 were reviewed. Surgical success was defined as intraocular pressure (IOP) between 5 and 21 mm Hg with or without antiglaucoma medications. Failure was defined as IOP ≤5 or ≥21 mm Hg for 2 consecutive visits, or when an additional glaucoma surgery was required to control IOP. Survival curves were analyzed using multilevel mixed-effect Weibull model.
A total of 81 eyes from 55 PCG patients were included. Surgical procedures involved 20 goniotomies, 15 trabeculotomies, 16 trabeculectomies, 15 CTT, and 15 TSCPC. Median follow-up time was 24 months (interquartile range: 9 to 60 mo). Overall success rates were 68.8% at 1 year, 63.8% at 3 years, and 53.7% at 5 years. All types of surgery except TSCPC had comparable cumulative 1 year success rates ranging from 78.5% to 83.3%. Cumulative success rates of trabeculotomy (80.05%) and CTT (79.4%) were maintained at 3 and 5 years and were the highest among all procedures at 5 years. TSCPC had a significantly lower success rate compared with other types of surgery (hazard ratio: 7.4 to 13.1, all P=0.01). All patients receiving primary TSCPC showed no success at 48 months.
Primary trabeculotomy and primary CTT demonstrated the highest long-term success rates in PCG patients.
报告泰国先天性青光眼（PCG）患者的长期手术成功率。
回顾了 1992 年 1 月至 2018 年 1 月期间接受以下一种主要手术的 PCG 患者：小梁切开术、房角切开术、小梁切除术、联合小梁切开小梁切除术（CTT）和二极管经巩膜睫状体光凝术（TSCPC）。手术成功定义为眼压（IOP）在 5 至 21mmHg 之间，无需抗青光眼药物。失败定义为连续 2 次就诊时眼压≤5 或≥21mmHg，或需要额外的青光眼手术来控制眼压。使用多级混合效应威布尔模型分析生存曲线。
共纳入 55 例 PCG 患者的 81 只眼。手术方法包括 20 例房角切开术、15 例小梁切开术、16 例小梁切除术、15 例 CTT 和 15 例 TSCPC。中位随访时间为 24 个月（四分位距：9 至 60 个月）。1 年总体成功率为 68.8%，3 年为 63.8%，5 年为 53.7%。除 TSCPC 外，所有手术类型的 1 年累积成功率均相当，范围为 78.5%至 83.3%。小梁切开术（80.05%）和 CTT（79.4%）的累积成功率在 3 年和 5 年均保持稳定，并且在 5 年时所有手术类型中最高。TSCPC 的成功率明显低于其他手术类型（风险比：7.4 至 13.1，均 P=0.01）。所有接受原发性 TSCPC 的患者在 48 个月时均未成功。
原发性小梁切开术和原发性 CTT 为 PCG 患者提供了最高的长期成功率。
