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,χ^2=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。
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 thatχ^2=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
作者
李海军
任静
杨潇远
刘茜
董良
LI Haijun;REN Jing;YANG Xiaoyuan;LIU Qian;DONG Liang(Henan Provincial People’s Hospital and Henan Eye Institute,Zhengzhou 450000,Henan Province,China)
出处
《眼科新进展》
CAS
北大核心
2020年第12期1143-1146,共4页
Recent Advances in Ophthalmology
基金
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)。
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
ab externo microcatheter-assisted circumferential trabeculotomy
conventional partial trabeculotomy
primary congenital glaucoma
