微导管引导的外路小梁切开术治疗儿童青光眼的短期疗效  

Outcomes of microcatheter-assisted trabeculotomy in childhood glaucoma

作　　者：王博 狄浩浩[2] 杨潇远[3] 高传文[2] 陈鹏[2] 王怀洲[4] WANG Bo;DI Hao-hao;YANG Xiao-yuan;GAO Chuan-wen;CHEN Peng;WANG Huai-zhou(Ineye Hospital of Chengdu University of T.C.M.,Chengdu 610000,China;The Second Hospital of Zhengzhou City,Zhengzhou 450000,China;Henan Provincial Eye Hospital,Henan Institute of Ophthalmology,Zhengzhou 450000,China;Beijing Tongren Eye Center,Beijing Key Laboratory of Ophthalmology and Visual Sciences,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]成都中医大银海眼科医院,610000 [2]郑州市第二人民医院,450000 [3]河南省眼科研究所河南省立眼科医院,郑州450000 [4]首都医科大学附属北京同仁医院北京同仁眼科中心眼科学与视觉科学北京市重点实验室,100730

出　　处：《眼科》2019年第3期178-181,共4页Ophthalmology in China

基　　金：河南省科技攻关项目(182102310432);首都临床特色应用研究与成果推广(Z16110700050000)

摘　　要：目的评估微导管引导的小梁切开术治疗初次手术和既往手术失败的儿童青光眼患者的有效性和安全性。设计回顾性病例系列。研究对象2017年4月至2018年5月郑州市第二人民医院接受微导管引导的小梁切开术的儿童青光眼患者28例(39眼)。方法回顾初次手术组(A组,15例22眼)及再次手术组(B组,13例17眼)患者手术前后的眼压、降眼压药物使用情况及术后并发症。比较两组术前、术后末次随访眼压及降眼压药物使用数量的变化及手术成功率。随访时间为6~17个月(中位数为13个月)。主要指标眼压、降眼压药物种类、手术成功率。结果A组术前平均眼压(31.23±6.05) mmHg,术后末次随访平均眼压(15.14±4.63)mmHg(t=8.40,P<0.05);术前使用降压药种类的中位数(范围)为3(1~4),术后为0(0~2)(Z=3.97,P<0.05)。B组术前平均眼压(29.47±5.75)mmHg,末次随访平均眼压(15.65±4.03)mmHg(t=6.97,P<0.05);术前使用降压药种类的中位数为3(1~4),术后为0(0~2)(Z=3.75,P<0.05)。末次随访A组完全成功率为77.27%,B组为88.24%(P=0.438)。所有患者术中及术后均无严重并发症。结论随访半年以上的结果显示,微导管引导的小梁切开术治疗初次手术和再次手术的儿童青光眼均具有较好的疗效,且无严重并发症发生。Objective To evaluate the efficacy and safty of microcatheter-assisted trabeculotomy for the childhood glaucoma with or without previous surgeries. Design Retrospective case series. Participants 28 cases (39 eyes) of children with primary congenital glaucoma (PCG) were treated with microcatheter-assisted trabeculotomy at Zhengzhou Second People's Hospital from April 2017 to May 2018. Methods 28 cases (39 eyes) were divided into two groups according to the surgery history. Group A (15 cases, 22 eyes) had no previous anterior chamber angle surgery. Group B (13 cases, 17 eyes) had one or more previous failed angle surgeries. The intraocular pressure(IOP), the number of the drugs for reducing intraocular pressure, and postoperative complications in two groups were observed. Main Outcome Measures IOP, number of drugs for reducing intraocular pressure, surgical success rate. Results Mean IOP decreased from (31.23±6.05) mmHg on 3 (median, range: 1~4) medications in Group A and (29.47±5.75) mmHg on 3 (median, range: 1~4) medications in Group B preoperatively to (15.14±4.63) mmHg on 0 (median, range: 0~2) medications in Group A and (15.65±4.03) mmHg on 0 (median, range: 0~2) medications in Group B at last visit respectively (all P<0.05). Complete success rate (77.27% vs 88.24%, P>0.05) were comparable between Group A (90.91%) and Group B (94.12%). Complications were minimal. Conclusion The result of 6 months or over shows that microcatheter-assisted trabeculotomy is effective and safe in the treatment of PCG for those children who have no previous angle surgery or those children who had one or more previous failed angle surgeries.

关 键 词：青光眼 小梁切开术 儿童 

分 类 号：R779.6[医药卫生—眼科]