前房角镜辅助内路小梁切开术治疗原发性儿童青光眼效果观察

doi:10.13281/j.cnki.issn.1004-4469.2022.02.006

眼科 ›› 2022, Vol. 31 ›› Issue (2): 109-114.doi: 10.13281/j.cnki.issn.1004-4469.2022.02.006

前房角镜辅助内路小梁切开术治疗原发性儿童青光眼效果观察

高传文¹ 张维嘉² 狄浩浩¹ 秦书娟¹ 荆晶¹ 赵志玲¹ 贾飞¹ 王怀洲²

¹郑州市第二人民医院暨南大学附属郑州医院眼科 450000； ²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

收稿日期:2021-12-08 出版日期:2022-03-25 发布日期:2022-03-25
通讯作者: 王怀洲，Email：trhz_wang@163.com
基金资助:
河南省医学科技攻关计划联合共建项目（LHGJ20191012）

Efficacy and safety of gonioscopy assisted transluminal trabeculotomy (GATT) for primary childhood glaucoma

Gao Chuanwen¹, Zhang Weijia², Di Haohao¹, Qin Shujuan¹, Jin Jing¹, Zhao Zhiling¹, Jia Fei¹, Wang Huaizhou²

¹Department of Ophthalmology, Zhengzhou Second Hospital, Zhengzhou Hospital, Jinan University, Zhengzhou 450000, China; ² Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing 100730, China

Received:2021-12-08 Online:2022-03-25 Published:2022-03-25
Contact: Wang Huaizhou, Email: trhz_wang@163.com
Supported by:
Henan Province Medical Science and Technology Research Program Joint Construction Project（LHGJ20191012）

摘要/Abstract

摘要： 目的评估前房角镜辅助内路小梁切开术治疗原发性儿童青光眼的中远期效果和安全性。设计回顾性病例系列。研究对象 2018年4月至2019年7月郑州市第二人民医院前房角镜辅助内路小梁切开术治疗的原发性先天性青光眼（PCG）8例（9眼），手术时平均年龄（2.4±1.5）岁；青少年性青光眼（JOAG）15例（20眼），手术时平均年龄（19.0±7.2）岁。方法回顾患者的病历资料，记录术前、术后末次随访时眼压、抗青光眼药物使用数量以及术中、术后并发症情况。术后不使用降眼压药物时眼压≤21 mmHg 为完全成功；使用降眼压药物时眼压≤21 mmHg为条件成功。平均随访（27.5±3.7）个月（24~36个月）。主要指标 眼压、抗青光眼药物使用数量、术中及术后并发症。结果术前平均眼压（30.4±12.2）mmHg，平均用药3种（2~5）种。末次随访平均眼压（14.3±3.5） mmHg，平均用药0种（0~3）种，二者均较术前显著下降（P均<0.001）。末次随访手术完全成功率、条件成功率分别为72.4%和93.1%。术后前房出血发生率为100%。术后早期眼压反弹发生率为48.3%（14/29眼），主要发生于青少年性青光眼患者。所有患者均无严重手术并发症发生。结论前房角镜辅助内路小梁切开术治疗原发性儿童青光眼具有较好的中长期降眼压效果及安全性。（眼科，2022，31： 109-114）

关键词: 前房角镜辅助内路小梁切开术, 原发性先天性青光眼, 青少年性开角型青光眼

Abstract: Objective To evaluate the efficacy and safety of gonioscopy assisted transluminal trabeculotomy (GATT) for the surgical management of primary childhood glaucoma. Design Retrospective case series. Participants Consecutive 8 primary congenital glaucoma (PCG) patients (9 eyes) with mean age 2.4±1.5 years old and 15 juvenile open angle glaucome(JOAG) patients (20 eyes) with mean age 19.0±7.2 years old underwent GATT between April 2018 and July 2019 by a single surgeon in Zhengzhou Second Hospital. Methods Medical records of patients were reviewed. Intraocular pressure (IOP) and usage of anti-glaucoma medication were compared between before surgery and last visit after surgery. Surgical success was defined as a postoperative IOP of ≤ 21 mmHg with (qualified success) or without (complete success) the use of anti-glaucoma medication. Mean follow-up time was 27.5±3.7 months (range 24-36 months). Main Outcome Measures IOP, number of anti-glaucoma medications, surgical complications. Results Post-operative IOP (14.3±3.5 mmHg) and number of anti-glaucoma medication (0, range 0-3) decreased significantly compared with the pre-operative values (30.4±12.2) mmHg (t=7.4, P＜0.001), 3 (range2~5） (z=-4.7, P＜0.001), respectively. The complete success rate was 72.4% and the qualified success rate was 93.1%. Hyphema was seen in all eyes (29/29, 100%), 14/29(48.3%) eyes had IOP spike in early stage after surgery. There was no severe complications occurred in all cases. Conclusion GATT has a medium and long-term effectiveness and is safety in the management of PCG and JOAG. （Ophthalmol CHN, 2022, 31: 109-114）

Key words: gonioscopy assisted transluminal trabeculotomy (GATT), primary congenital glaucoma (PCG), juvenile open angle glaucoma (JOAG)

高传文张维嘉狄浩浩秦书娟荆晶赵志玲贾飞王怀洲. 前房角镜辅助内路小梁切开术治疗原发性儿童青光眼效果观察[J]. 眼科, 2022, 31(2): 109-114.

Gao Chuanwen, Zhang Weijia, Di Haohao, Qin Shujuan, Jin Jing, Zhao Zhiling, Jia Fei, Wang Huaizhou. Efficacy and safety of gonioscopy assisted transluminal trabeculotomy (GATT) for primary childhood glaucoma[J]. Ophthalmology in China, 2022, 31(2): 109-114.

[1]	陈霄雅王瑞雪丁文君卢亚楠. 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[J]. 眼科, 2022, 31(5): 334-339.
[2]	王怀洲辛晨石砚李猛王宁利. 外路微导管辅助的360度小梁切开术治疗青少年性开角型青光眼和原发性开角型青光眼的临床对照研究[J]. 眼科, 2021, 30(1): 20-24.
[3]	王怀洲1 胡曼2 辛晨1 石砚1 李猛1 王宁利1. 微导管辅助的小梁切开术治疗原发性先天性青光眼的远期疗效观察[J]. 眼科, 2020, 29(1): 15-19.
[4]	石砚王怀洲尹鹏辛晨万月梁新童王宁利. 微导管引导的内路小梁切开术治疗原发性先天性青光眼六个月的疗效[J]. 眼科, 2019, 28(3): 165-168.

前房角镜辅助内路小梁切开术治疗原发性儿童青光眼效果观察

Efficacy and safety of gonioscopy assisted transluminal trabeculotomy (GATT) for primary childhood glaucoma

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