Glaucoma Service, Farabi Eye Hospital, Tehran, Iran.
Glaucoma Service, Farabi Eye Hospital, Tehran, Iran.
J AAPOS. 2022 Jun;26(3):121.e1-121.e6. doi: 10.1016/j.jaapos.2021.12.010. Epub 2022 Apr 14.
To investigate the outcome of viscocanalostomy combined with trabeculotomy (VCO+tbo) in primary congenital glaucoma (PCG) with history of failed trabeculotomy.
In this prospective study, VCO+tbo was performed in 75 eyes of 46 patients with PCG who had not responded adequately to one angle surgery. Success was defined as intraocular pressure (IOP) of 6-21 mm Hg and at least 20% IOP drop at the last postoperative visit with (qualified) or without (complete) glaucoma medications.
Patients completed a mean follow-up of 31 ± 11 months. Complete success was achieved in 6 eyes (8%); qualified success, in 38 eyes (51%). In the 44 successfully treated eyes, IOP was reduced from a preoperative mean of 29.0 ± 5.8 to 15.7 ± 2.6 mm Hg, and the number of medications dropped from 2.6 ± 0.9 to 2.0 ± 1.0 (P < 0.001). In univariate analysis, the success rate was lower in patients with neonatal onset disease than subjects whose age at onset was 1-12 months (HR = 0.22; 95% CI, 0.05-0.93; P = 0.039). Children whose disease was first diagnosed after 1 year of age responded better than neonatal onset patients but worse than those with age of onset of 1-12 months; however, the difference was not statistically significant. Hyphema occurred in 27 eyes (36%) on day 1 and resolved spontaneously. Iatrogenic cyclodialysis occurred in one eye, which was surgically repaired after 1 month of treatment with cycloplegic agents.
In our study cohort, VCO+tbo was associated with successful outcomes in the majority of treated eyes.
研究伴有小梁切开术失败史的原发性先天性青光眼（PCG）行粘小管切开联合小梁切开术（VCO+tbo）的结果。
在这项前瞻性研究中，对 46 例曾行 1 次抗青光眼手术但眼压控制不佳的 PCG 患者的 75 只眼行 VCO+tbo。成功定义为末次随访时眼压（IOP）为 6-21mmHg，且与（合格）或不（完全）使用降眼压药物相比，IOP 下降至少 20%。
患者平均随访 31±11 个月。6 只眼（8%）获得完全成功，38 只眼（51%）获得合格成功。在 44 只成功治疗的眼中，IOP 从术前的 29.0±5.8mmHg 降至 15.7±2.6mmHg，用药数从 2.6±0.9 降至 2.0±1.0（P<0.001）。单因素分析显示，新生儿期发病患者的成功率低于发病年龄为 1-12 个月的患者（HR=0.22；95%CI，0.05-0.93；P=0.039）。1 岁后发病的患儿的反应优于新生儿期发病的患儿，但比发病年龄为 1-12 个月的患儿差，但差异无统计学意义。27 只眼（36%）第 1 天出现前房积血，自发吸收。1 只眼发生医源性睫状体分离，用睫状肌麻痹剂治疗 1 个月后手术修复。
在我们的研究队列中，VCO+tbo 可使大多数治疗眼获得成功的结果。
