Department of Ophthalmology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
Ophthalmic Res. 2023;66(1):958-967. doi: 10.1159/000531143. Epub 2023 Jun 16.
The aim of the study was to evaluate the efficacy and safety of combined trabeculotomy-non-penetrating deep sclerectomy (CTNS) in the treatment of Sturge-Weber syndrome (SWS) secondary glaucoma.
This retrospective study reviewed cases that underwent CTNS as initial surgery for SWS secondary glaucoma at our Ophthalmology Department center from April 2019 to August 2020. Surgical success was defined as an intraocular pressure (IOP) ≤ 21 mm Hg with (qualified success) or without (complete success) the use of anti-glaucoma medications. IOP >21 mm Hg or <5 mm Hg despite 3 or more applications of anti-glaucoma medications on 2 consecutive follow-up visits or at the last follow-up, performance of additional glaucoma (IOP-lowering) surgery, or with vision-threatening complications were classified as failure.
A total of 22 eyes of 21 patients were included. Twenty-one eyes were of early-onset type and 1 eye was of adulthood onset. For Kaplan-Meier survival analysis, the overall success rates at 1st and 2nd years were 95.2% and 84.9%, while the complete success rates at 1st and 2nd years were 42.9% and 36.7%. At the last follow-up (22.3 ± 4.0 months, range: 11.2∼31.2), overall success was achieved in 19 (85.7%) eyes and complete success in 12 (52.4%) eyes. Postoperative complications included transient hyphema (11/22, 50.0%) and transient Ⅰ degree shallow anterior chamber (1/22, 4.5%), and retinal detachment (1/22, 4.5%). No other severe com plications were detected during the follow-up.
CTNS significantly reduces IOP in SWS secondary glaucoma patients who have serious episcleral vascular malformation. CTNS in SWS secondary glaucoma patients is safe and effective for short and medium periods. A randomized controlled study comparing the long-term prognosis of SWS early-onset and late-onset glaucoma underwent CTNS is worth conducting.
本研究旨在评估小梁切开联合非穿透性深层巩膜切除术（CTNS）治疗 Sturge-Weber 综合征（SWS）继发青光眼的疗效和安全性。
本回顾性研究纳入了 2019 年 4 月至 2020 年 8 月期间在我院眼科中心接受 CTNS 作为 SWS 继发青光眼初始手术的病例。手术成功定义为眼压（IOP）≤21mmHg（有（合格成功）或无（完全成功）抗青光眼药物）。IOP＞21mmHg 或＜5mmHg，尽管在 2 次连续随访或最后一次随访时应用了 3 种或更多种抗青光眼药物，或需要进行额外的青光眼（降低眼压）手术，或出现威胁视力的并发症，则归类为失败。
共纳入 21 例 22 只眼。21 只眼为早发型，1 只为成年发病。Kaplan-Meier 生存分析显示，第 1 年和第 2 年的总体成功率分别为 95.2%和 84.9%，第 1 年和第 2 年的完全成功率分别为 42.9%和 36.7%。在最后一次随访（22.3±4.0 个月，范围：11.2∼31.2）时，19 只眼（85.7%）达到总体成功，12 只眼（52.4%）达到完全成功。术后并发症包括一过性前房积血（11/22，50.0%）和一过性浅前房Ⅰ度（1/22，4.5%）和视网膜脱离（1/22，4.5%）。在随访期间未发现其他严重并发症。
CTNS 可显著降低存在严重巩膜血管畸形的 SWS 继发青光眼患者的眼压。CTNS 治疗 SWS 继发青光眼在短中期内是安全有效的。值得开展一项比较 CTNS 治疗 SWS 早发型和晚发型青光眼的长期预后的随机对照研究。
