目的:探讨小梁切开术和房角切开术治疗小儿无晶状体眼青光眼的效果。方法:选择1997/2010年接受先天性白内障手术后进而因无晶状体眼青光眼接受小梁切开术和房角切开术的患儿。手术治疗成功的标准是术后眼压≤24mmHg,无论是否需要局部药物的辅助使用,且避免了小梁切除术或引流阀植入,在随访期间没有明显并发症。排除标准:眼前段发育不全、小角膜、白内障手术时即发生的青光眼、随访<1a。结果:符合纳入标准10例12眼。其中,2眼仅行房角切开术,2眼房角切开术后进而接受了小梁切开术,8眼仅行小梁切开术。房角手术前平均眼压为35±10mmHg,末次随访的平均眼压为22±4mmHg(P=0.0005)。12眼中有7眼获得了成功(58%):5眼(42%)是在单一的小梁切开术后获取成功的,2眼(17%)在接受房角切开术后进而于术后7mo和15mo时接受了引流阀植入。结论:小梁切开术和房角切开术治疗小儿无晶状体眼青光眼的效果满意。

AIM:To investigate the outcome of trabeculotomy and/ or goniotomy for pediatric aphakic glaucoma. METHODS:Retrospective chart review of consecutive children who had congenital cataract surgery between 1997 and 2010 and required goniotomy and/or trabeculotomy for aphakic glaucoma.Treatment success was defined as postoperative intraocular pressure≤24mmHg despite topical medication use,avoidance of trabeculectomy or shunt placement,and no visually significant complications in the follow-up period. Exclusion criteria included a diagnosis of anterior segment dysgenesis,microcornea,and glaucoma at the time of cataract surgery,and follow-up less than 1 year. RESULTS:Totally 10 patients 12 eyes met inclusion criteria.Of theses,2 eyes had goniotomy alone,2 eyes had goniotomy followed by trabeculotomy,and 8 eyes had trabeculotomy alone.Mean IOP before angle surgery was 35±10mmHg.Mean IOP at the last recorded visit was 22±4mmHg(P=0.0005).Treatment success was observed in 7 of the 12 eyes(58%):5 eyes(42%) were successful after a single angle surgery,each involving an initial trabeculotomy;2 eyes(17%) underwent subsequent shunt placement after initial goniotomy at 6 months and 1.3 years after the last angle surgery. CONCLUSION:When intraocular surgery is indicated to control IOP in pediatric aphakic glaucoma,trabeculotomy and/or goniotomy can be successful in the majority of eyes and may decrease the need for filtering and shunting procedures.

R779.6

中国广东省医学科学技术研究基金项目(No.2007055)~~