Xu S X, Ye W Q, Zhang J T, Li J X, Xie Y Q, Zhang S D, Li G X, Liang Y B
National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China.
Department of Ophthalmology, the Affiliated People's Hospital of Ningbo University, Ningbo 315040, China.
Zhonghua Yan Ke Za Zhi. 2024 May 11;60(5):416-422. doi: 10.3760/cma.j.cn112142-20231030-00196.
To investigate the clinical characteristics and treatment outcomes of glaucoma secondary to congenital ectropion uveae (CEU) using penetrating Schlemm's canaloplasty. This was a retrospective case series study. Medical records of patients diagnosed with glaucoma secondary to CEU and undergoing penetrating Schlemm's canaloplasty at the Eye Hospital of Wenzhou Medical University between August 2020 and December 2021 were collected. Clinical characteristics including the extent and location of iris ectropion, type of glaucoma, were analyzed. Follow-up visits were conducted at 1, 3, 6 months, and 1 year postoperatively. Visual acuity, intraocular pressure (IOP), anterior segment and fundus condition, filtering bleb morphology, use of IOP-lowering medications, ultrasound biomicroscopy results, and other indicators were analyzed to summarize surgical outcomes. Six cases (6 eyes) of glaucoma secondary to CEU were included, all unilateral, with 3 left eyes and 3 right eyes; median age was 10.0 (5.3, 28.8) years; including 3 males and 3 females. Preoperative IOP was (31.7±10.0) mmHg (1 mmHg=0.133 kPa), and the preoperative number of IOP-lowering medications used was 2.0 (2.0, 3.2). The extent of iris ectropion in the 6 cases ranged from 270 ° to 360 °, with peripheral anterior synechiae corresponding to the location of iris ectropion, and angle closure with the degree of synechiae extending beyond Schwalbe's line. No surgical complications occurred in any of the 6 cases postoperatively. At 1 month postoperatively, the IOP was (16.4±3.2) mmHg, with a median of 0.0 (0.0, 1.5) medications used. At 3 months postoperatively, the IOP was (14.8±6.0) mmHg, with a median of 0.0 (0.0, 2.2) medications used. At 6 months postoperatively, the IOP was (18.1±6.1) mmHg, with a median of 0.0 (0.0, 0.5) medications used. Among them, 5 patients had a follow-up period of 1 year postoperatively, all achieving controlled IOP without the use of IOP-lowering medications, with an average IOP of (15.5±3.1) mmHg. No obvious filtering bleb formation was observed at the surgical site in all patients. Glaucoma secondary to CEU manifests primarily as closed-angle glaucoma, with a correspondence between the closure range of anterior iris adhesions in the angle and the extent of iris ectropion. Penetrating Schlemm's canaloplasty demonstrates favorable and stable efficacy for its treatment.
采用穿透性施莱姆管成形术研究先天性葡萄膜外翻(CEU)继发性青光眼的临床特征和治疗效果。这是一项回顾性病例系列研究。收集了2020年8月至2021年12月在温州医科大学附属眼视光医院被诊断为CEU继发性青光眼并接受穿透性施莱姆管成形术的患者的病历。分析了包括虹膜外翻的范围和位置、青光眼类型等临床特征。术后1、3、6个月和1年进行随访。分析视力、眼压(IOP)、眼前节和眼底情况、滤过泡形态、降眼压药物的使用、超声生物显微镜检查结果等指标,以总结手术效果。纳入6例(6只眼)CEU继发性青光眼患者,均为单眼,左眼3例,右眼3例;中位年龄为10.0(5.3,28.8)岁;包括3名男性和3名女性。术前眼压为(31.7±10.0)mmHg(1 mmHg = 0.133 kPa),术前使用降眼压药物的数量为2.0(2.0,3.2)。6例患者的虹膜外翻范围为270°至360°,周边前粘连与虹膜外翻部位相对应,房角关闭且粘连程度超过施瓦贝线。6例患者术后均未发生手术并发症。术后1个月,眼压为(16.4±3.2)mmHg,使用药物的中位数为0.0(0.0,1.5)。术后3个月,眼压为(14.8±6.0)mmHg,使用药物的中位数为0.0(0.0,2.2)。术后6个月,眼压为(18.1±6.1)mmHg,使用药物的中位数为0.0(0.0,0.5)。其中,5例患者术后随访1年,均在未使用降眼压药物的情况下眼压得到控制,平均眼压为(15.5±3.1)mmHg。所有患者手术部位均未观察到明显的滤过泡形成。CEU继发性青光眼主要表现为闭角型青光眼,房角前虹膜粘连的闭合范围与虹膜外翻程度相对应。穿透性施莱姆管成形术治疗该病疗效良好且稳定。