Mandal A K, Naduvilath T J, Jayagandan A
VST Centre for Glaucoma Care, L. V. Prasad Eye Institute, Hyderabad, India.
Ophthalmology. 1998 Jun;105(6):974-82. doi: 10.1016/S0161-6420(98)96022-5.
The purpose of the study was to evaluate the surgical outcome of combined trabeculotomy-trabeculectomy in different types of primary developmental glaucomas.
A retrospective review of all cases of primary developmental glaucomas that underwent primary combined trabeculotomy-trabeculectomy between August 1990 and September 1995, with a minimum follow-up of 6 months, was performed.
One hundred and eighty-two eyes of 120 patients were included in this study; 122 (67%) eyes had congenital glaucoma; 22 (12.1%) eyes had infantile glaucoma; and 38 (20.9%) eyes had juvenile glaucoma.
Primary combined trabeculotomy-trabeculectomy was the chosen intervention.
Preoperative and postoperative intraocular pressures, visual acuities, success rate, corneal clarity and diameters, bleb characteristics, time of surgical failure, and complications were the main outcome measures.
Intraocular pressure (mean +/- SD) reduced from a preoperative level of 26.5 +/- 8.3 mmHg; 30.3 +/- 9.9 mmHg; and 31.8 +/- 11.5 mmHg to 13.1 +/- 5.8 mmHg; 13.7 +/- 4.4 mmHg; and 13.3 +/- 6.0 mmHg in the congenital, infantile, and juvenile types of developmental glaucomas, respectively. Kaplan-Meier survival analysis showed that the success probability at 6 months was 94.4% +/- 2.3%; 90.9% +/- 6.1%; and 81.0% +/- 7.3% in the three groups, respectively. The success probability of patients with juvenile glaucoma was significantly lower than it was for those with congenital glaucoma (P = 0.0393). Of 182 eyes, 105 (57.7%) eyes had corneal edema at presentation. Eighty-one (79%) of 105 eyes had complete clearance of corneal edema postoperatively (P < 0.0001). The follow-up period ranged from 6 months to 48 months (mean, 10.7 +/- 12.0 months). There were no sight-threatening intraoperative and postoperative complications in any patient.
Primary combined trabeculotomy-trabeculectomy is safe, effective, and sufficiently predictable to be considered the first choice of surgical treatment in primary congenital glaucoma with corneal edema. Juvenile glaucoma has the worst prognosis, and infantile glaucoma has a better prognosis than does juvenile glaucoma.
本研究旨在评估小梁切开术联合小梁切除术治疗不同类型原发性发育性青光眼的手术效果。
对1990年8月至1995年9月期间接受原发性小梁切开术联合小梁切除术且随访至少6个月的所有原发性发育性青光眼病例进行回顾性研究。
本研究纳入了120例患者的182只眼；122只眼（67%）患有先天性青光眼；22只眼（12.1%）患有婴儿性青光眼；38只眼（20.9%）患有青少年性青光眼。
选择原发性小梁切开术联合小梁切除术作为干预措施。
术前和术后眼压、视力、成功率、角膜清晰度和直径、滤过泡特征、手术失败时间及并发症为主要观察指标。
先天性、婴儿性和青少年性发育性青光眼的眼压（均值±标准差）分别从术前的26.5±8.3 mmHg、30.3±9.9 mmHg和31.8±11.5 mmHg降至13.1±5.8 mmHg、13.7±4.4 mmHg和13.3±6.0 mmHg。Kaplan-Meier生存分析显示，三组在6个月时的成功概率分别为94.4%±2.3%、90.9%±6.1%和81.0%±7.3%。青少年性青光眼患者的成功概率显著低于先天性青光眼患者（P = 0.0393）。182只眼中，105只眼（57.7%）在就诊时有角膜水肿。105只眼中的81只眼（79%）术后角膜水肿完全消退（P < 0.0001）。随访时间为6个月至48个月（平均10.7±12.0个月）。所有患者术中及术后均未出现威胁视力的并发症。
原发性小梁切开术联合小梁切除术安全、有效且具有足够的可预测性，可被视为原发性先天性青光眼合并角膜水肿手术治疗的首选。青少年性青光眼预后最差，婴儿性青光眼的预后优于青少年性青光眼。
