Quan Ann V, Chen Jenny, Wang Ye Elaine, Vanner Elizabeth A, Grajewski Alana L, Hodapp Elizabeth A, Chang Ta Chen
From Scripps Health (A.V.Q.), Department of Ophthalmology, San Diego, California, USA.
UC Davis Eye Center (J.C.), University of California Davis Medical Center, Sacramento, California, USA.
Am J Ophthalmol. 2022 Sep;241:168-178. doi: 10.1016/j.ajo.2022.04.023. Epub 2022 May 9.
To identify the factors associated with the complications and failure of gonioscopy-assisted transluminal trabeculotomy (GATT) in children.
Retrospective case series.
This study was conducted in an institutional setting in a pediatric population (aged <18 years) who had undergone GATT. Records were reviewed, and pre- and postoperative intraocular pressures (IOP), extent of angle treated, medications, complications, and failure were recorded. Failure was defined as IOP >21 mm Hg or <5 mm Hg, absence of at least 20% IOP reduction, performance of additional IOP-lowering surgery, or loss of light perception vision.
A total of 74 eyes of 57 patients were included (mean age, 7.1 years). Over a median follow-up period of 28.5 months, 36 eyes (48.6%) failed. IOP spikes occurred in 25 eyes (33.8%) and were a significant risk factor for failure (hazard ratio [HR] = 2.17; P = .0207). Postoperative hyphema was a significant risk factor for IOP spike (HR = 4.13, P = .003) but not for failure (HR = 0.7, P = .2977). The risk of IOP spike was lowest in eyes treated with nonsteroidal anti-inflammatory drugs (NSAIDs; HR = 0.27, P = .0016). The risk of failure increased significantly in eyes that received topical corticosteroids (compared to NSAIDs; HR = 5.72, P = .0005), in eyes with <360 incisions (HR = 4.69, P < .0001), and in younger children.
GATT is a reasonably effective procedure in childhood glaucoma. Postoperatively, the use of topical NSAIDs (without corticosteroid) may decrease the risk of failure. Eyes with IOP spikes without hyphema are at the highest risk for failure.
确定与儿童房角镜辅助小梁切开术（GATT）并发症及失败相关的因素。
回顾性病例系列研究。
本研究在一家机构中对接受GATT的儿科人群（年龄<18岁）进行。查阅记录，并记录术前和术后眼压（IOP）、房角治疗范围、用药情况、并发症及手术失败情况。手术失败定义为眼压>21 mmHg或<5 mmHg、眼压降低未达至少20%、进行额外的降眼压手术或无光感视力丧失。
共纳入57例患者的74只眼（平均年龄7.1岁）。在中位随访期28.5个月时，36只眼（48.6%）手术失败。25只眼（33.8%）出现眼压峰值，是手术失败的显著危险因素（风险比[HR]=2.17；P=0.0207）。术后前房积血是眼压峰值的显著危险因素（HR=4.13，P=0.003），但不是手术失败的危险因素（HR=0.7，P=0.2977）。使用非甾体类抗炎药（NSAIDs）治疗的眼眼压峰值风险最低（HR=0.27，P=0.0016）。接受局部皮质类固醇治疗的眼（与NSAIDs相比；HR=5.72，P=0.0005）、切口<360°的眼（HR=4.69，P<0.0001）以及年龄较小的儿童手术失败风险显著增加。
GATT是治疗儿童青光眼的一种相当有效的手术方法。术后使用局部NSAIDs（不使用皮质类固醇）可能会降低手术失败风险。无前房积血但出现眼压峰值的眼手术失败风险最高。
