内窥镜辅助与外路微导管引导的小梁切开术治疗原发性先天性青光眼的有效性和安全性对比  

Comparison of the efficacy and safety of endoscopic-assisted transluminal trabeculotomy and microcatheter-assisted trabeculotomy for primary congenital glaucoma

作　　者：陈霄雅 王瑞雪 丁文君 卢亚楠 Chen Xiaoya;Wang Ruixue;Ding Wenjun;Lu Yanan(Clinical Research Center for Ophthalmology,Xuzhou First People's Hospital,Eye Disease Prevention and Treatment Institute of Xuzhou,The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University,Xuzhou 221116,Jiangsu,China)

机构地区：[1]徐州医科大学附属徐州市立医院,徐州市第一人民医院眼科临床研究中心,徐州市眼病防治研究所,221116

出　　处：《眼科》2022年第5期334-339,共6页Ophthalmology in China

基　　金：江苏省青年医学重点人才培养计划(QNRC2016364)。

摘　　要：目的比较内窥镜辅助微导管引导的小梁切开术(EATT)与外路微导管引导的小梁切开术(MAT)治疗合并角膜混浊的原发性先天性青光眼(PCG)的有效性和安全性。设计回顾性病例系列。研究对象2020年1月至2021年10月在徐州市第一人民医院实施EATT手术的PCG患者16例(20)眼及MAT手术者17例(21眼)。EATT组及MAT组的平均年龄分别为(40.4±26.9)个月和(38.3±29.0)个月。方法回顾患者术前及术后1、3、6、9、12个月的病历资料,记录各时间点眼压、局部使用降眼压药物数量、手术成功率及术后并发症。手术完全成功定义为无局部降眼压药物使用时眼压<21 mmHg,条件成功定义为联合局部降眼压药物时眼压<21 mmHg。主要指标眼压、局部降眼压药物数量、手术成功率及术后并发症。结果所有患者随访≥6个月。EATT组术后12个月时眼压(15.8±3.1)mmHg,低于术前的(36.3±7.0)mmHg(Z=-3.408,P=0.001);MAT组术后12个月时眼压(17.2±3.7)mmHg,低于术前的(35.5±6.2)mmHg(Z=-3.519,P<0.001)。两组内各个时间点局部降眼压药物数量均较术前显著下降(P均<0.01);EATT组与MAT组间各个时间点眼压均无显著性差异(P均>0.05)。术后12个月的手术完全成功率EATT组71.4%,MAT组68.8%,条件成功率EATT组85.7%,MAT组81.3%,两组间比较差异均无统计学意义(P=0.888,0.748)。两组间在术后前房出血及一过性高眼压的发生率比较均无统计学差异(χ^(2)=1.003,0.344,P=0.317,0.558)。两组均无其他严重并发症。结论本研究随访12个月的小样本量研究结果显示,EATT与MAT治疗伴有角膜混浊的PCG的有效性和安全性无明显差异,EATT为伴有角膜混浊的PCG患者提供一种新的内路手术选择方式。(眼科,2022,31:334-339)Objective To evaluate the efficacy and safety of endoscopic-assisted transluminal trabeculotomy(EATT)and microcatheter-assisted trabeculotomy(MAT)in the treatment of primary congenital glaucoma(PCG).Design Retrospective case series.Participants Consecutive 16 patients(20 eyes)with PCG underwent EATT and 17 patients(21 eyes)with PCG underwent MAT in the Xuzhou First People's Hospital from January 2020 to October 2021.The mean age of EATT group and MAT group was(40.4±26.9)months and(38.3±29.0)months,respectively.Method The medical records of the patients before operation and 1,3,6,9,12 months after operation were reviewed.Intraocular pressure(IOP),numbers of anti-glaucoma medication,the rate of surgical success and postoperative complications were recorded.Success was defined as IOP<21 mmHg with(qualified success)or without(absolute success)the use of anti-glaucoma medication.Main Outcome Measures IOP,numbers of anti-glaucoma medication,the rate of absolute success and qualified success,postoperative complications.Results All cases were followed up for≥6 months.In EATT group,the IOP at 12 months postoperatively was lower than that before operation,which was(15.8±3.1)mmHg and(36.3±7.0)mmHg respectively(Z=-3.408,P=0.001).In MAT group,the IOP at 12 months postoperatively were lower than that before operation too,which was(17.2±3.7)mmHg and(35.5±6.2)respectively(Z=-3.519,P<0.001).In both groups,the IOP and numbers of anti-glaucoma medication were significantly decreased at all time points of the follow-up periods compared to the preoperative values(all P<0.01).There was no statistical significance in IOP between the two groups(all P>0.05).At 12 months postoperatively,the absolute success rates were 71.4%in EATT group and 68.8%in MAT group,and the qualified success rates were 85.7%in EATT group and 81.3%in MAT group.There were no statistical significance between the two groups(P=0.888,0.748).There were no significant differences in the incidence of anterior chamber hemorrhage and transient intraocular hypertensi

关 键 词：内窥镜辅助微导管引导的小梁切开术 外路微导管引导的小梁切开术 原发性先天性青光眼 

分 类 号：R779.6[医药卫生—眼科]