A Department, Hedi Rais Institute of Ophthalmology, Tunis El-Manar University.
B Department, Hedi Rais Institute of Ophthalmology, Tunis El-Manar University, Tunis.
J Glaucoma. 2023 Oct 1;32(10):848-853. doi: 10.1097/IJG.0000000000002229. Epub 2023 Apr 10.
Primary congenital glaucoma (PCG) in Tunisian children seems to be characterized by a high prevalence of inherited and advanced forms of the disease. Primary combined trabeculotomy trabeculectomy (CTT) allowed satisfactory long-term intraocular pressure (IOP) control and reasonable visual outcome.
To report the long-term outcome of CTT as the initial glaucoma surgery in children with PCG.
Retrospective analysis of children who underwent primary CTT for PCG between January 2010 and December 2019. The main outcome measures were IOP reduction, corneal clarity, complications, refractive errors, and visual acuity (VA). Success was defined as IOP <16 mm Hg without (complete) or with (qualified) antiglaucoma medication. The WHO criteria of vision loss were used to categorize visual impairment (VI).
Of 62 patients, 98 eyes were enrolled. At the last follow-up, the mean IOP was reduced from 22.7 ± 4.0 mm Hg to 9.7 ± 3.9 mm Hg ( P < 0.0001). The complete success rate was 91.6%, 88.4%, 84.7%, 71.6%, 59.7%, and 54.3%, at the first, second, fourth, sixth, eighth, and tenth year, respectively. Follow-up averaged 42.1 ± 28.4 months. Preoperatively, 72 eyes (73.5%) had significant corneal edema versus 11 eyes (11.2%) at the end of the follow-up ( P < 0.0001). Endophthalmitis was encountered in one eye. Myopia was the most common refractive error (80.6%). Data on Snellen VA were available for 53.2% of the patients; 33.3% achieved a VA ≥6/12, 21.2% had mild VI, 9.1% had moderate VI, 21.2% had severe VI, and 15.2% were blind. The failure rate was statistically correlated to the early disease onset (<3 mo) and to preoperative corneal edema ( P = 0.022 and P = 0.037, respectively).
Primary CTT seems to be a good procedure in a population with advanced PCG at presentation, problematic follow-up visits, and limited resources.
突尼斯儿童的原发性先天性青光眼（PCG）似乎具有遗传性和疾病晚期形式高发的特点。原发性联合小梁切开小梁切除术（CTT）可实现令人满意的长期眼压（IOP）控制和合理的视力预后。
报告 CTT 作为儿童 PCG 初始青光眼手术的长期结果。
回顾性分析 2010 年 1 月至 2019 年 12 月期间接受原发性 CTT 治疗的 PCG 儿童。主要观察指标包括眼压降低、角膜透明度、并发症、屈光不正和视力（VA）。成功定义为眼压<16mmHg，无需（完全）或需要（合格）抗青光眼药物。使用世界卫生组织（WHO）视力丧失标准对视力障碍（VI）进行分类。
62 例患者，98 只眼纳入研究。末次随访时，平均眼压从 22.7±4.0mmHg 降至 9.7±3.9mmHg（P<0.0001）。第 1、2、4、6、8、10 年的完全成功率分别为 91.6%、88.4%、84.7%、71.6%、59.7%和 54.3%。平均随访时间为 42.1±28.4 个月。术前 72 只眼（73.5%）存在显著角膜水肿，而末次随访时仅 11 只眼（11.2%）存在（P<0.0001）。1 只眼发生眼内炎。近视是最常见的屈光不正（80.6%）。53.2%的患者可提供 Snellen VA 数据；33.3%的患者视力≥6/12，21.2%的患者轻度 VI，9.1%的患者中度 VI，21.2%的患者重度 VI，15.2%的患者失明。失败率与疾病早期发病（<3 个月）和术前角膜水肿（P=0.022 和 P=0.037）呈统计学相关。
原发性 CTT 似乎是一种很好的术式，适用于就诊时疾病晚期、随访困难和资源有限的人群。
