Surgical Results in the Management of Advanced Primary Congenital Glaucoma in a Rural Pediatric Population
Surgical Results in the Management of Advanced Primary Congenital Glaucoma in a Rural Pediatric Population
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DOI：
10.1016/j.ophtha.2010.02.027
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发表时间：
2011-02-01
期刊：
影响因子：
13.7
通讯作者：
Helveston, Eugene M.
中科院分区：
文献类型：
--
作者：
Ben-Zion, Itay;Tomkins, Oren;Helveston, Eugene M.
目的：介绍农村地区晚期先天性青光眼(PCG)手术治疗的解剖和功能结果。设计：回顾性观察病例系列。研究对象：连续22例(40只眼)先天性青光眼患者，均接受手术治疗。记录手术类型和术后并发症。主要观察指标：视力(VA)、眼压(IOP)、屈光度、杯盘比(CDR)、水平角膜直径(HCD)。结果：手术时年龄0.4~10岁，平均3.3岁；随访1~11个月，平均6个月。15%的患者出现明显的晶状体脱位，原因是眼球突出。术前眼压54+/-2 mm，HCD 15.1+/-0.3 mm，CDR(可见时)0.8+/-0.02。手术治疗包括小梁切除术31例，Ahmed青光眼阀门植入术6例，青光眼切开术1例，眼内容物摘除2例。4只眼出现严重并发症。术后眼压为23+/-2毫米汞柱(P<；0.0001)。术后患者出现可活动视力(以下指标或更好)的可能性显著增加(18%比%；P<；0.0001)。结论：晚期PCG患儿的手术结果显示，眼压总体上有中等程度的改善，视力也有轻微改善。深度剥夺性弱视、严重的疾病表现、角膜混浊和频繁的晶状体脱位限制了手术的成功。这些数据进一步表明，需要对儿童进行有效、及时的筛查，并迅速得到卫生保健工作者的承认，以降低发展中国家可避免的盲目率。
Objective: To present the anatomic and functional results of surgical treatment for advanced primary congenital glaucoma (PCG) in a rural setting.Design: Retrospective, observational case series.Participants: Forty eyes of 22 consecutive patients diagnosed with PCG and who underwent surgical treatment.Methods: All eyes underwent surgical treatment for PCG. Type of surgery and postoperative complications were noted. We examined anatomic and functional indices before and after the operation.Main Outcome Measures: Visual acuity (VA), intraocular pressure (IOP), refractive spherical error, cup-to-disc ratio (CDR), and horizontal corneal diameter (HCD).Results: Average age at the time of surgery was 3.3 years (range, 0.4-10) and the mean follow-up was 6 months (range, 1-11). 15% showed marked lens dislocation owing to the severe buphthalmos at presentation. Preoperative IOP was 54 +/- 2 mmHg, HCD was 15.1 +/- 0.3 mm, and CDR (when visible) was 0.8 +/- 0.02. Surgical intervention included 31 trabeculotomies, 6 Ahmed Glaucoma Valve implants, 1 goniotomy, and 2 eviscerations. Serious complications were noted in 4 eyes. Final postoperative IOP was 23 +/- 2 mmHg (P < 0.0001). Patients were significantly more likely to have ambulatory VA (following objects or better) after operation (18% vs 64%; P < 0.0001).Conclusions: Our surgical outcomes in children with advanced PCG demonstrated moderate overall improvement in IOP and modest improvement of VA. Deep deprivation amblyopia, severe disease manifestation at presentation, opaque corneas, and frequent lens dislocation limited the possible success. These data further signify the need for effective, timely screening of children and prompt recognition by health care workers to reduce the rate of avoidable blindness in developing countries.