小梁切开术治疗原发性先天性青光眼的远期疗效  

Long-term effect of trabeculotomy on primary congenital glaucoma

作　　者：才瑜[1] 李美玉[1] 沈亚云[1] 刘丽娜[1] 

机构地区：[1]北京大学第一医院眼科,100034

出　　处：《中华眼科杂志》2004年第11期733-736,共4页Chinese Journal of Ophthalmology

摘　　要：目的　评价小梁切开术治疗原发性先天性青光眼的远期疗效。方法　回顾性分析 2 2例 (33只眼 )原发性先天性青光眼患者首次行小梁切开术的远期疗效。手术成功的判定标准 :不用或仅局部应用抗青光眼药物 ,眼压≤ 2 1mmHg(1mmHg =0 133kPa) ,且角膜清亮 ,角膜横径和杯 /盘比值减小或未进展者。结果　患者随访时间均在 1年以上 ,平均随访 (5 4 2± 33 2 )个月 ,随访 3年以上者占 72 7%。术后平均眼压 (16 1± 6 2 )mmHg ,较术前眼压 (2 9 9± 11 7)mmHg明显降低(P <0 0 0 1) ;术后平均角膜横径 (12 9± 1 0 )mm较术前 (13 7± 1 4 )mm明显减少 (P =0 0 0 2 ) ,手术前后平均杯 /盘比值差异无显著意义 (P =0 14 8)。手术成功者其杯 /盘比值明显减小 (术前 0 7± 0 2 ,术后 0 6± 0 3,P =0 0 0 7)。根据上述手术成功标准 ,手术成功率 1、3、5年分别为 97 0 %、93 2 %及74 5 % (Kaplan Meier生存分析 )。接受 1次手术者 2 0只眼 ,手术成功率为 70 0 % ;接受 2次以上手术者 13只眼 (39 6 % ) ,再手术成功率为 6 9 2 %。矫正视力≥ 0 4者占 4 1 6 % ,0 1～ 0 3者占 2 9 2 % ,<0 1者占 2 9 2 %。杯 /盘比值 >0 8者是造成低视力的危险因素 (线性回归分析 ,P =0 0 13)。本组Objective To evaluate the long-term effect of trabeculotomy on primary congenital glaucoma. Methods This retrospective study included primary congenital glaucoma patients who underwent trabeculotomy as an initial surgery between 1988 and 1999 with follow-up at least one year. Definitions of successful operation were determined as (1) intraocular pressure (IOP) ≤ 21 mm Hg with clear cornea,(2) no antiglaucoma medication or only local medication of topical antiglaucoma drops, and (3) no adverse progression in cup-disc ratio (C/D) and cornea diameter, or cup-disc ratio (C/D) and cornea diameter reduced compared to pre-operation. Results The study included 33 eyes with 72.7% patients who were followed-up for over three years. The mean follow-up time was (54.2±33.2) months. After trabeculotomy, the average IOP was significantly lowered to (16.1±6.2) mm Hg from (29.9±11.7) mm Hg ((P< 0.001);) and cornea diameter was significantly reduced to (12.9±1.0) mm from (13.7±1.4) mm (P=0.002). Although there was no significant difference in the average C/D after operation (P=0.148), the change in C/D was significantly different in patients in the success group [(0.7±0.2)mm, pre-operation,(0.6±0.3)mm, post-operation, P=0.007]. Based on the criteria for successful operation, the success rate of trabeculotomy was 97.0%, 93.2, 74.5% at one, three and five years by Kaplan-Meier analysis respectively . For 20 eyes which received only one operation, the success rate was 70.0%. However, in the rest of 13 eyes (39.6%) that had received two or more operations, the success rate was reduced slightly to 69.2%. In patients with successful operations, 41.7% of patients had correct visual acuity≥0.4, 29.1% between 0.1 and 0.3, and 29.2%≤0.1. By linear regression analysis, it was found that C/D > 0.8 (P=0.013) was risk factor responsible for poor vision. Among 18 eyes that were examined for visual field, glaucomatous visual field loss was found in 14 eyes (77.7%). Early-stage defect was seen in 42.8%, intermediate-stage in 28.6

关 键 词：治疗 小梁切开术 原发性先天性青光眼 远期疗效 手术成功率 并发症 术后 结论 比值 中华 

分 类 号：R779.6[医药卫生—眼科]