微导管辅助小梁切开术治疗儿童青光眼的疗效  

Clinical Efficacy of Ab Externo Microcatheter-Assisted Trabeculotomy in Childhood Glaucoma

作　　者：刘伟伟[1] 杨潇远 马聪慧 卢跃兵 李海军 金鑫 任静 董良 Weiwei Liu;Xiaoyuan Yang;Conghui Ma;Yuebing Lu;Haijun Li;Xin Jin;Jing Ren;Liang Dong(Department of Ophthalmology,Zhengzhou Children's Hospital,Children's Hospital of Henan Province,Zhengzhou University Affiliated Children's Hospital,Zhengzhou 450000,China;Henan Eye Hospital,Henan Eye Institute,the People's Hospital of Henan Province,Zhengzhou 450000,China)

机构地区：[1]郑州大学附属儿童医院,河南省儿童医院,郑州儿童医院眼科,郑州450000 [2]河南省立眼科医院,河南省眼科研究所,河南省人民医院眼科,郑州450000

出　　处：《中华眼视光学与视觉科学杂志》2022年第3期221-226,共6页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：河南省卫生健康科技英才海外研修工程(HWYX2019123);河南省省部共建项目(SBGJ2018072)。

摘　　要：目的:观察微导管辅助的小梁切开术治疗儿童青光眼的临床效果及术后1年切开小梁的开放情况。方法:前瞻性临床研究。纳入2018年1月至2019年12月于河南省立眼科医院青光眼中心接受微导管辅助的小梁切开术治疗的4~16岁儿童青光眼患者21例(28眼)。观察记录患者手术前后最佳矫正视力(BCVA)、眼压、抗青光眼药物使用数量、房角情况、术中及术后并发症。术后随访1年。采用配对t检验、Wilcoxon符号秩和检验、Kruskal-WallisH检验、Spearman秩相关分析等对数据进行分析。结果:所有患者均完成了微导管辅助的小梁切开术,其中完全切开16例(22眼),次全切开5例(6眼)。术前及术后末次随访的BCVA(LogMAR视力)分别为0.80(0.00~2.00)和0.75(0.00~1.60),差异无统计学意义(Z=-1.41,P=0.157)。术前及术后末次随访的眼压分别为(30.4±4.8)mmHg(1 mmHg=0.133 kPa)和(14.1±4.5)mmHg,末次随访眼压较术前明显降低(t=14.11,P<0.001)。术前使用降眼压药物数量中位数为3(1~4),末次随访时下降至0(0~3)(Z=-4.35,P<0.001)。末次随访时切开小梁开放范围中位数为302.5°(70°~360°)。所有患者中15例(21眼)手术完全成功,4例(5眼)条件成功,2例(2眼)手术失败,这3类患者切开小梁开放范围中位数分别为330°(210°~360°)、205°(180°~225°)、85°(70°~100°),差异有统计学意义(χ^(2)=15.20,P=0.001)。切开小梁开放范围与眼压呈负相关(r=-0.82,P<0.001)。结论:微导管辅助的小梁切开术治疗儿童青光眼具有良好的临床效果,且术后切开小梁开放范围是影响患者预后的重要因素。Objective:To investigate the clinical efficacy of ab externo microcatheter-assisted trabeculotomy(MAT)in childhood glaucoma and the open range of the incised trabecular meshwork one year after surgery.Methods:This was a prospective clinical study.21 patients(28 eyes)with childhood glaucoma,aged 4-16 years,were enrolled in the glaucoma center of Henan Eye Hospital from January 2018 to December 2019.All patients underwent ab externo MAT.Patients were followed up for one year after surgery.The best corrected visual acuity(BCVA),intraocular pressure(IOP),usage of anti-glaucoma medication,the condition of the anterior chamber angle and complications were observed and analyzed.A paired t test,Wilcoxon signed-rank test,Kruskal-Wallis H test,and Spearman rank correlation were used to analyze the data.Results:All patients underwent ab externo MAT successfully.Surgery on 16 patients(22 eyes)was performed with full incisions and surgery on 5 patients(6 eyes)was performed with a subtotal incision.Preoperative BCVA(median:0.8,range:0.00-2.00)was not significantly different from postoperative BCVA(median:0.75,range:0.00-1.60)(Z=-1.41,P=0.157).Preoperative and postoperative IOPs were 30.4±4.8 mmHg(1 mmHg=0.133 kPa)and 14.1±4.5 mmHg,respectively.The difference was statistically significant(t=14.11,P<0.001).The amount of the postoperative anti-glaucoma medication(median:0,range:0-3)was significantly lower than preoperative levels(median:3,range:1-4)(Z=-4.35,P<0.001).At the last follow-up,the open range of the incised trabecular meshwork median was 302.5°(range:70°-360°).Fifteen cases(21 eyes)and 4 cases(5 eyes)achieved complete and qualified success;2 cases(2 eyes)failed.The open range medians of the incised trabecular meshwork of the 3 groups were 330°(210°-360°),205°(180°-225°),and 85°(70°-100°)at the last visit.The open ranges of the different groups were statistically significant(χ^(2)=15.20,P=0.001).The open range of incised trabecular meshwork was negatively correlated with intraocular pressure(r=-0.82,P<0.00

关 键 词：微导管辅助的小梁切开术 青光眼 眼压 房角 儿童 

分 类 号：R779.6[医药卫生—眼科]