微导管辅助的小梁切开术治疗激素性青光眼的长期疗效分析  

Long-term outcome of microcatheter-assisted trabeculotomy in patients with steroid-induced glaucoma

作　　者：姚仁杰 张文静[1] 黄雪桃 祁颖[1] YAO Renjie;ZHANG Wenjing;HUANG Xuetao;QI Ying(Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan Province,China)

机构地区：[1]郑州大学第一附属医院眼科,河南省郑州市450052

出　　处：《眼科新进展》2022年第4期289-293,共5页Recent Advances in Ophthalmology

基　　金：国家自然科学基金资助(编号81970785)。

摘　　要：目的观察微导管辅助的小梁切开术(MAT)治疗激素性青光眼(SIG)患者的长期安全性与有效性。方法前瞻性病例系列研究。纳入2019年10月至2020年10月在郑州大学第一附属医院治疗的<40岁明确诊断为SIG的患者,所有患者均接受MAT治疗并完成360°小梁切开手术。术后随访不少于12个月,观察患者的最佳矫正视力(BCVA)、眼压(IOP)、使用抗青光眼药物种类、手术成功率和并发症情况。结果共纳入15例18眼,其中男8例(53.3%,9眼),女7例(46.7%,9眼),患者手术时年龄为11~39(25.7±9.6)岁,术后随访时间为12~15(12.9±0.9)个月。患者术后末次随访时IOP为(14.44±3.10)mmHg(1 kPa=7.5 mmHg),较术前基线IOP(38.41±9.69)mmHg显著降低(P<0.0001)。使用的抗青光眼药物种类的中位数由术前的3(1~4)种降至0(0~1)种,差异有统计学意义(P<0.05)。末次随访时患者的BCVA(logMAR)为0~5.0(1.12±1.31),与术前0~5.0(1.54±1.60)比较,差异无统计学意义(P=0.2984)。术后12个月时,患者手术的条件成功率为100.0%,完全成功率为88.9%。术后18眼(100.0%)均发生一过性前房积血(0~II级),4眼(22.2%)发生一过性浅前房,1眼(5.6%)发生一过性低IOP,未见其他严重并发症。结论MAT治疗年轻SIG患者的手术成功率高,具有良好的远期降IOP效果且无严重并发症发生。Objective To survey the long-term safety and effectiveness of microcatheter-assisted trabeculotomy(MAT)in the treatment of steroid-induced glaucoma(SIG).Methods A prospective case series study was designed.SIG patients aged below 40 years who were treated in the First Affiliated Hospital of Zhengzhou University from October 2019 to October 2020 were included.All patients received MAT and 360°trabeculotomy.During the follow-up 12 months and above,the best corrected visual acuity(BCVA),intraocular pressure(IOP),anti-glaucoma drugs used,surgical success rate,and complications of the patients were recorded.Results A total of 15 patients(18 eyes)were enrolled,including 8 males with 9 eyes(53.3%)and 7 females with 9 eyes(46.7%).The age of the patients at the time of surgery was 11-39(25.7±9.6)years,and the postoperative follow-up period was 12-15(12.9±0.9)months.Patients’IOP at the last follow-up after surgery was 9.0-18.6(14.44±3.10)mmHg(1 kPa=7.5 mmHg),which was significantly lower than the preoperative baseline of 24.2-56.7(38.41±9.69)mmHg(P<0.05).The median of the types of anti-glaucoma drugs used decreased from 3(1-4)preoperatively to 0(0-1)postoperatively,and the difference was statistically significant(P<0.05).At the last follow-up,patients’BCVA(logMAR)was 0-5.0(1.12±1.31),which was not significantly different from preoperative BCVA of 0-5.0(1.54±1.60)(P=0.2984).At 12 months postoperatively,the conditional success rate of the surgery was 100.0%,and the complete success rate was 88.9%.After surgery,transient hyphema(grade 0-II)occurred in 18 eyes(100.0%),transient shallow anterior chamber occurred in 4 eyes(22.2%),transient hypotension occurred in 1 eye(5.6%),while no other serious complications occurred.Conclusion MAT shows a high surgical success rate in the treatment of young patients with SIG,with a long-term IOP lowering effect and no serious complications.

关 键 词：微导管辅助的小梁切开术 激素性青光眼 糖皮质激素 

分 类 号：R775.3[医药卫生—眼科]