[1]李海军,任静,杨潇远,等.外路全周或部分小梁切开术治疗原发性先天性青光眼患者对照研究[J].眼科新进展,2020,40(12):1143-1146.[doi:10.13389/j.cnki.rao.2020.0254]
　LI Haijun,REN Jing,YANG Xiaoyuan,et al.Ab externo circumferential trabeculotomy versus partial trabeculotomy for primary congenital glaucoma patients[J].Recent Advances in Ophthalmology,2020,40(12):1143-1146.[doi:10.13389/j.cnki.rao.2020.0254]
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外路全周或部分小梁切开术治疗原发性先天性青光眼患者对照研究/HTML
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
40卷
期数:
2020年12期
页码:
1143-1146
栏目:
应用研究
出版日期:
2020-12-05

文章信息/Info

Title:
Ab externo circumferential trabeculotomy versus partial trabeculotomy for primary congenital glaucoma patients
文章编号:
1143
作者:
李海军; 任静; 杨潇远; 刘茜; 董良
450000　河南省郑州市，河南省眼科研究所，河南省人民医院，河南眼科临床研究中心
Author(s):
LI Haijun; REN Jing; YANG Xiaoyuan; LIU Qian; DONG Liang
Henan Provincial People’s Hospital and Henan Eye Institute,Zhengzhou 450000， Henan Province,China
关键词:
微导管辅助全周小梁切开术; 部分小梁切开术; 先天性青光眼
Keywords:
ab externo microcatheter-assisted circumferential trabeculotomy;  conventional partial trabeculotomy;  primary congenital glaucoma
分类号:
R775.4
DOI:
10.13389/j.cnki.rao.2020.0254
文献标志码:
A
摘要:
目的　比较外路微导管辅助全周小梁切开术（microcatheter assisted circumferential trabeculotomy，MAT）与Harm刀辅助部分小梁切开术（conventional partial trabeculotomy，CPT）治疗原发性先天性青光眼（primary congenital glaucoma,PCG）患者的疗效。方法　回顾性研究。纳入2016年4月至2018年4月在河南省人民医院治疗的PCG患儿，按初次手术方式分为2组，即MAT组与CPT 组，术后随访均不少于2 a，观察眼压、并发症、降眼压药物使用情况及角膜透明度等指标，比较两种术式的安全性与有效性。结果　共纳入34例（41眼）患儿，MAT组18例（22眼），CPT组16例（19眼），年龄（30.1±28.8）周，MAT组和CPT组术前基线眼压分别为（28.45±3.87）mmHg（1 kPa=7.5 mmHg)、（29.05±2.52）mmHg；末次随访时MAT组和CPT组眼压分别为（15.80±5.69) mmHg、（19.28±7.65） mmHg，均较术前显著降低(均为P<0.05),但两组间相比差异无统计学意义(P=0.246)。末次随访时MAT组和CPT组总体有效率分别为86.36%和78.95%（Z=-1.93，P=0.847），MAT组 2 a累积生存率为81.3%，CPT组2 a累积生存率为73.2%，采用K-M生存分析，Log-Rank检验示,χ2=0.584，P=0.445。MAT组角膜直径术前（12.3±1.2）mm，术后降低至（11.4±0.9）mm （P=0.004），CPT组从术前（12.4±1.5）mm降为（11.9±1.1）mm（P=0.002），术后组间比较差异无统计学意义（P=0.135）。术后MAT组角膜混浊率从54.55%降为40.91%（P=0.761），CPT组从52.63%降为42.11%（P=0.744），术后组间比较差异无统计学意义（P=0.921）。末次随访时两组间降眼压药物使用种类差异无统计学意义（P=0.328）。术后所有患眼均发生前房积血，CPT组发生白内障、脉络膜脱离各1眼，MAT组未见脉络膜脱离及白内障发生。结论　MAT和CPT均能有效控制PCG患儿眼压，且MAT较CPT降压幅度更大，远期有效率更高，并发症更少。
Abstract:
Objective　To compare the efficacy of ab externo microcatheter-assisted circumferential trabeculotomy (MAT) and conventional partial trabeculotomy (CPT) with rigid probe for primary congenital glaucoma (PCG).Methods　A retrospective study was designed. The patients with PCG who were treated in Henan Provincial People’s Hospital from April 2016 to April 2018 were divided into 2 groups according to the initial operation method, namely the MAT group and the CPT group. The postoperative follow-ups were both> 2 years for observing and comparing the intraocular pressure (IOP), complications, the use of lowering intraocular pressure drugs and corneal transparency and other indicators to evaluate the safety and effectiveness of the two procedures.Results　A total of 34 children (41 eyes) were enrolled, 18 children (22 eyes) in the MAT group, 16 children (19 eyes) in the CPT group, aged (30.1±28.8) weeks, baseline IOP before surgery was (28.45±3.87) mmHg (1 kPa=7.5 mmHg) in the MAT group and (29.05±2.52) mmHg in the CPT group. At the last follow-up, the IOP of the MAT group and the CPT group were (15.80±5.69) mmHg and (19.28±7.65) mmHg, respectively, which were significantly lower than those before the operation (both P<0.05). But the difference between the two groups was not statistically significant (P=0.246). At the last follow-up, the overall effective rates of the MAT group and the CPT group were 86.36% and 78.95% (Z=-1.93, P=0.847). The cumulative survival rate for 2 years in the MAT group was about 81.3%. The cumulative survival rate of the group was 73.2%. K-M survival analysis was used, and Log-Rank test showed that χ2=0.584, P=0.445. The corneal diameter in the MAT group was (12.3±1.2) mm before the operation and decreased to (11.4±0.9) mm after the operation (P=0.004), while it was reduced from (12.4±1.5) mm before the operation to (11.9±1.1) mm in the CPT group (P=0.002), and there was no statistically significant difference between the groups after operation (P=0.135). The corneal opacity rate in the MAT group decreased from 54.55% to 40.91% (P=0.761), and the rate in the CPT group decreased from 52.63% to 42.11% (P=0.744), and there was no statistically significant difference between them after operation (P=0.921). There was no significant difference in the types of IOP lowering drugs between the two groups at the last follow-up (P=0.328). After operation, anterior chamber hemorrhage occurred in all eyes, 1 eye with cataract and 1 eye with choroidal detachment occurred in CPT group, while no choroidal detachment or cataract occurred in the MAT group.Conclusion　Both MAT and CPT can effectively control IOP in children with PCG, and MAT has a greater reduction in IOP than CPT, with higher long-term efficiency and fewer complications.

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备注/Memo

备注/Memo:
国家自然科学基金资助项目（编号：U1904166）；河南省省部共建项目（编号：SBGJ2018072）
更新日期/Last Update: 2020-12-05