Aktas Zeynep, Gulpinar Ikiz Gokcen Deniz
Department of Ophthalmology, Atilim University School of Medicine, Ankara, Türkiye.
Department of Ophthalmology, Medical Park, Ankara, Türkiye.
Front Ophthalmol (Lausanne). 2023 Mar 22;3:1101281. doi: 10.3389/fopht.2023.1101281. eCollection 2023.
Pediatric glaucoma surgery is challenging due to its diverse and complex pathophysiology, altered anterior segment anatomy, greater potential for failure, and complications compared to adult patients. Moreover, numerous challenges are associated with long-term postoperative management. Thus, when dealing with childhood glaucoma, it is important to consider the potential complications in addition to the benefits of each intervention. The purpose of this article is to review recently published literature to shed light on the most recent surgical techniques for the safe and effective treatment of childhood glaucoma. Current literature shows that goniotomy and trabeculotomy are the first choices for the management of primary congenital glaucoma. Although older children with phakic eyes seem to benefit from trabeculectomy with adjunctive mitomycin C, it carries a long-term risk of bleb-related endophthalmitis. Glaucoma drainage devices may be preferred for patients with secondary or refractory glaucoma. However, hypotony or tube-related complications are common and encountered more often in children than in adults. Cyclodestructive procedures are also an option for cases in which filtering surgery has failed, but they can also be used as a temporizing measure to reduce the rate of complications in high-risk patients. However, their outcomes can be unpredictable, in terms of efficiency and complications. Finally, minimally invasive glaucoma surgery (MIGS) as the sole alternative treatment or as an adjunctive surgical procedure is a relatively new path for pediatric patients.
小儿青光眼手术具有挑战性，因为与成年患者相比，其病理生理多样且复杂，眼前段解剖结构改变，手术失败和出现并发症的可能性更大。此外，术后长期管理存在诸多挑战。因此，在处理儿童青光眼时，除了考虑每种干预措施的益处外，还需考虑潜在的并发症。本文旨在回顾近期发表的文献，以阐明安全有效治疗儿童青光眼的最新手术技术。当前文献表明，前房角切开术和小梁切开术是原发性先天性青光眼治疗的首选方法。虽然有晶状体眼的大龄儿童似乎可从联合丝裂霉素C的小梁切除术获益，但该手术存在与滤过泡相关的眼内炎的长期风险。对于继发性或难治性青光眼患者，青光眼引流装置可能是更优选择。然而，低眼压或与引流管相关的并发症很常见，且在儿童中比在成人中更常出现。对于滤过性手术失败的病例，睫状体破坏手术也是一种选择，但它们也可作为一种临时措施，以降低高危患者的并发症发生率。然而，就疗效和并发症而言，其结果可能不可预测。最后，微创青光眼手术（MIGS）作为唯一的替代治疗方法或辅助手术方法，对小儿患者来说是一条相对较新的途径。
