Mandal Anil K, Gothwal Vijaya K, Ali Mohammed Hasnat
Jasti V Ramanamma Children's Eye Care Centre, Child Sight Institute; VST Centre for Glaucoma Care.
Meera and L B Deshpande Centre for Sight Enhancement, Institute for Vision Rehabilitation; Brien Holden Eye Research Centre - Patient Reported Outcomes Unit,; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.
Ophthalmol Glaucoma. 2025 Jul 21. doi: 10.1016/j.ogla.2025.07.005.
To report the clinical outcomes in patients with primary congenital glaucoma (PCG) managed over a period of 13 years.
Retrospective cohort study.
Eleven hundred- fifty eyes of 704 patients undergoing surgery for PCG between January 2011 and December 2023 with a minimum follow-up of 6 months.
Medical records of children with PCG were reviewed, and demographic and clinical data were collected. Patients who underwent primary combined trabeculotomy-trabeculectomy (CTT) without mitomycin-C (MMC) as an initial procedure were included (n=1128 eyes). Complete success was defined as intraocular pressure (IOP) ≥6 mmHg and ≤16 mmHg without glaucoma medications and qualified success when one glaucoma medication was required. Failure was defined as uncontrolled IOP with more than one glaucoma medication, need for repeat surgery, chronic hypotony (IOP <6 mmHg on 2 consecutive visits at one month interval) or any sight-threatening complications.
IOP control, number of glaucoma medications, visual acuity and success rate.
The mean (SD) age of patients at first surgery was 23.1 (44.7) months (range, 9 days to 233 months; median, 5 months) and mean (SD) follow-up was 60.1 (49,6) months. Infantile-onset PCG was the most common form (61%) of presentation. Primary CTT without MMC was performed in 1128 eyes (98.1%). Complete success rate was 85.9%, 69.7%, and 37.8%, at the first, fifth, and tenth year, respectively. The corresponding complete plus qualified success rate was 98.2%, 93.3%, and 84.1% respectively. Overall, infantile-onset PCG showed better success rates than other two groups. There was a significant reduction in IOP at last follow-up (43.4%; P < 0.0001). Preoperatively, majority of eyes (n=937, 81.5%) were using glaucoma medications whereas at last follow-up, 388 eyes (41.4%) required medications (P<0.0001). Of the 690 eyes (60%) that presented with corneal edema, 622 eyes (90%) had clear cornea at last follow-up (P<0.0001). At last follow-up, 190 eyes (23.1%) had visual acuity of ≥20/40. Multivariate Cox proportional hazards analysis revealed level of IOP and corneal diameter to be independent risk factors for poor surgical outcome.
Our large cohort study treated by CTT without MMC is encouraging and may be considered as the initial surgical procedure in PCG. The outcomes were more favorable in children with infantile-onset PCG.
报告13年间原发性先天性青光眼（PCG）患者的临床治疗结果。
回顾性队列研究。
2011年1月至2023年12月期间，704例接受PCG手术的患者的1150只眼，随访时间至少6个月。
回顾PCG患儿的病历，收集人口统计学和临床数据。纳入最初接受无丝裂霉素C（MMC）的原发性小梁切开术-小梁切除术（CTT）的患者（n = 1128只眼）。完全成功定义为眼压（IOP）≥6 mmHg且≤16 mmHg，无需使用青光眼药物；当需要一种青光眼药物时为合格成功。失败定义为使用一种以上青光眼药物眼压仍控制不佳、需要再次手术、慢性低眼压（间隔1个月连续2次就诊时IOP < 6 mmHg）或任何威胁视力的并发症。
眼压控制、青光眼药物使用数量、视力和成功率。
首次手术时患者的平均（标准差）年龄为23.1（44.7）个月（范围9天至233个月；中位数5个月），平均（标准差）随访时间为60.1（49.6）个月。婴儿期发病的PCG是最常见的表现形式（61%）。1128只眼（98.1%）接受了无MMC的原发性CTT。第一年、第五年和第十年的完全成功率分别为85.9%、69.7%和37.8%。相应的完全加合格成功率分别为98.2%、93.3%和84.1%。总体而言，婴儿期发病的PCG成功率高于其他两组。末次随访时眼压显著降低（43.4%；P < 0.0001）。术前，大多数眼（n = 937，81.5%）使用青光眼药物，而在末次随访时，388只眼（41.4%）需要用药（P < 0.0001）。6%出现角膜水肿的690只眼中，622只眼（90%）在末次随访时角膜清亮（P < 0.0001）。末次随访时，190只眼（23.1%）视力≥20/40。多因素Cox比例风险分析显示眼压水平和角膜直径是手术效果不佳的独立危险因素。
我们这项关于无MMC的CTT治疗的大型队列研究结果令人鼓舞，可考虑作为PCG的初始手术方法。婴儿期发病的PCG患儿治疗效果更佳。
