Aktas Zeynep, Ucgul Ahmet Y, Boluk Ceyda E, Atalay Hatice T
Department of Ophthalmology, Medicana International Hospital, Atilim University.
Department of Ophthalmology, Gazi University School of Medicine, Ankara.
J Glaucoma. 2022 Dec 1;31(12):966-971. doi: 10.1097/IJG.0000000000002098. Epub 2022 Aug 9.
This study demonstrates that a baseline corneal diameter >12.25, initial age <4 months at diagnosis, higher baseline IOP than 24 mm Hg, bilaterality, or inability to perform circumferential trabeculotomy, increases the risk of surgical failure of trabeculotomy in patients with primary congenital glaucoma (PCG).
The aim of this study was to identify clinical predictive factors for surgical failure and to evaluate potential prognostic factors affecting surgical success in patients with PCG who underwent trabeculotomy.
The medical charts of 123 eyes of 75 patients who underwent trabeculotomy surgery for the treatment of PCG were retrospectively reviewed. At baseline and each visit, intraocular pressure (IOP), corneal diameter, cup to disc ratio, axial length, number of medications, and need for further glaucoma surgery were noted. Surgical success was defined as an IOP ≤18 mm Hg and 20% IOP reduction from baseline with (qualified) or without (complete) medication and without any further IOP-lowering surgery.
The mean age at surgery was 4.2±6.6 months and the mean follow-up time was 60.0±37.6 months. The receiver operating characteristic curve showed 4 following best cutoff values to predict surgical failure: the first for age at surgery was 4.5 months; the second baseline IOP was 24.0 mm Hg; the third for baseline cup to disc ratio was 0.4; and the fourth for baseline corneal diameter was 12.25 mm. Multivariate logistic regression analysis revealed that baseline IOP more than 24 mm Hg increased the risk of surgical failure by 2 times, baseline mean corneal diameter >12.25 mm did by 4.2 times, younger age than 4 months did by 2.5 times, bilaterality did by 1.5 times.
A higher baseline IOP, younger age, larger corneal diameter, and bilaterality were identified as risk factors for trabeculotomy failure in congenital glaucoma. The presence of one or more of these should be considered in the decision-making process when considering surgical options to manage glaucoma in these patients.
本研究表明，原发性先天性青光眼（PCG）患者小梁切开术手术失败的风险会因以下因素而增加：基线角膜直径>12.25、诊断时初始年龄<4个月、基线眼压高于24 mmHg、双侧患病，或无法进行环形小梁切开术。
本研究的目的是确定手术失败的临床预测因素，并评估影响接受小梁切开术的PCG患者手术成功的潜在预后因素。
回顾性分析75例接受小梁切开术治疗PCG患者的123只眼的病历。在基线和每次随访时，记录眼压（IOP）、角膜直径、杯盘比、眼轴长度、用药数量以及是否需要进一步的青光眼手术。手术成功定义为眼压≤18 mmHg，且眼压较基线降低20%（有用药[合格]或无用药[完全]），且无需任何进一步的降眼压手术。
手术时的平均年龄为4.2±6.6个月，平均随访时间为60.0±37.6个月。受试者工作特征曲线显示有4个预测手术失败的最佳临界值：第一个是手术年龄为4.5个月；第二个基线眼压为24.0 mmHg；第三个基线杯盘比为0.4；第四个基线角膜直径为12.25 mm。多因素逻辑回归分析显示，基线眼压超过24 mmHg使手术失败风险增加2倍，基线平均角膜直径>12.25 mm使风险增加4.2倍，年龄小于4个月使风险增加2.5倍，双侧患病使风险增加1.5倍。
较高的基线眼压（IOP）、年龄较小、角膜直径较大和双侧患病被确定为先天性青光眼小梁切开术失败的危险因素。在考虑为这些患者选择治疗青光眼的手术方案时，决策过程中应考虑这些因素中一个或多个因素的存在。
