Abstract：
OBJECTIVE: To estimate the long-term surgical and visual outcomes in patients with primary congenital glaucoma (PCG) who completed at least 20 years of follow-up.
METHODS: Retrospective study.
METHODS: Two hundred twenty eyes of 121 patients undergoing surgery for PCG between January 1991 and December 2000 and who returned for a follow-up visit from January 2021 through January 2022.
METHODS: Retrospective review of medical records of patients who underwent primary combined trabeculotomy-trabeculectomy (CTT) without mitomycin C as an initial procedure. Success was defined as complete when intraocular pressure (IOP) was ≥ 6 mmHg and ≤ 21 mmHg without glaucoma medication and as qualified when up to 2 glaucoma medications were required. Failure was defined as uncontrolled IOP with more than 2 glaucoma medications, need for a second IOP-lowering procedure, chronic hypotony (IOP < 6 mmHg on 2 consecutive visits), or any sight-threatening complication. A mixed-effects model using maximum likelihood estimation was used in estimation of eye-based variables and to make comparisons between different visits. Kaplan-Meier survival analysis was used to estimate the probabilities of surgical and functional successes. Cox proportional hazards regression using sandwich clustered estimation was used to evaluate risk factors for failure and poor visual outcome.
METHODS: Primary outcome measure was the proportion of patients who demonstrated complete success over the 20-year follow-up. Secondary outcome measures included rate of surgical failure and need for reoperation for glaucoma, visual acuity, refractive errors, risk factors for poor outcome, and complications.
RESULTS: Kaplan-Meier survival analysis revealed 1-year, 10-year, and 20-year complete success rates of 90.7%, 78.9%, and 44.5%, respectively. In univariate analysis, surgical failure was higher among patients with any additional non-glaucoma intraocular surgery. None of the clinical parameters were associated significantly with failure in multivariable analysis. Overall, the proportion of eyes with good, fair, and poor visual outcomes was 33.2%, 16.4%, and 50.4%, respectively. Myopia was seen in 68.9% eyes. Twenty-eight eyes of those who underwent primary CTT (14.4%) required second surgery for IOP control. No significant intraoperative complications occurred. Six eyes required enucleation because of painful blind eye.
CONCLUSIONS: In this large cohort of patients with PCG, CTT is a useful procedure. It provides good IOP control and moderate visual recovery that remained over a 20-year follow-up after surgery.
BACKGROUND: The author(s) have no proprietary or commercial interest in any materials discussed in this article.
METHODS: Retrospective study.
METHODS: Two hundred twenty eyes of 121 patients undergoing surgery for PCG between January 1991 and December 2000 and who returned for a follow-up visit from January 2021 through January 2022.
METHODS: Retrospective review of medical records of patients who underwent primary combined trabeculotomy-trabeculectomy (CTT) without mitomycin C as an initial procedure. Success was defined as complete when intraocular pressure (IOP) was ≥ 6 mmHg and ≤ 21 mmHg without glaucoma medication and as qualified when up to 2 glaucoma medications were required. Failure was defined as uncontrolled IOP with more than 2 glaucoma medications, need for a second IOP-lowering procedure, chronic hypotony (IOP < 6 mmHg on 2 consecutive visits), or any sight-threatening complication. A mixed-effects model using maximum likelihood estimation was used in estimation of eye-based variables and to make comparisons between different visits. Kaplan-Meier survival analysis was used to estimate the probabilities of surgical and functional successes. Cox proportional hazards regression using sandwich clustered estimation was used to evaluate risk factors for failure and poor visual outcome.
METHODS: Primary outcome measure was the proportion of patients who demonstrated complete success over the 20-year follow-up. Secondary outcome measures included rate of surgical failure and need for reoperation for glaucoma, visual acuity, refractive errors, risk factors for poor outcome, and complications.
RESULTS: Kaplan-Meier survival analysis revealed 1-year, 10-year, and 20-year complete success rates of 90.7%, 78.9%, and 44.5%, respectively. In univariate analysis, surgical failure was higher among patients with any additional non-glaucoma intraocular surgery. None of the clinical parameters were associated significantly with failure in multivariable analysis. Overall, the proportion of eyes with good, fair, and poor visual outcomes was 33.2%, 16.4%, and 50.4%, respectively. Myopia was seen in 68.9% eyes. Twenty-eight eyes of those who underwent primary CTT (14.4%) required second surgery for IOP control. No significant intraoperative complications occurred. Six eyes required enucleation because of painful blind eye.
CONCLUSIONS: In this large cohort of patients with PCG, CTT is a useful procedure. It provides good IOP control and moderate visual recovery that remained over a 20-year follow-up after surgery.
BACKGROUND: The author(s) have no proprietary or commercial interest in any materials discussed in this article.
摘要：
目的：评估完成至少20年随访的原发性先天性青光眼（PCG）患者的长期手术和视觉结果。
方法：回顾性临床数据库研究。
方法：在1991年1月至2000年12月期间接受PCG手术的121例患者的220只眼，从2021年1月至2022年1月进行随访。
方法：回顾性回顾初次接受小梁切开-小梁切除术（CTT）而不使用丝裂霉素C作为初始手术的患者的病历。成功定义为当IOP≥6mmHg和≤21mmHg时，不使用青光眼药物，而当需要两种青光眼药物时，成功定义为完全。需要重新手术以控制IOP的眼睛被认为是故障。使用最大似然估计的混合效应模型用于基于眼睛的变量的估计，并在不同访问之间进行比较。Kaplan-Meier生存分析用于评估手术和功能成功的概率。使用夹心聚类估计的Cox比例风险回归用于评估失败和不良视觉结果的风险因素。
方法：主要结果指标是在20年的随访中显示完全成功的患者比例。次要结果指标包括手术失败率和青光眼需要再次手术，视敏度,屈光不正,不良预后和并发症的危险因素。
结果：Kaplan-Meier生存分析显示1年，10年,20年完成成功率90.7%，78.9%和44.5%,分别。在单变量分析中，在进行任何额外眼内手术的患者中,手术失败率较高.然而,在多变量分析中,没有一项临床参数与失败显著相关.总的来说,眼睛的比例好，正常和不良的视觉结果为33.2％，16.4%和50.4%，分别。近视占68.9%。接受原发性CTT的患者中有28只眼（14.4％）需要进行第二次手术以控制IOP。术中无明显并发症。由于痛苦的失明，六只眼睛需要摘除。
结论：CTT在这一大型PCG患者队列中是一个有用的程序。它提供了良好的IOP控制和适度的视觉恢复，在手术后20年的随访中仍然存在。
方法：回顾性临床数据库研究。
方法：在1991年1月至2000年12月期间接受PCG手术的121例患者的220只眼，从2021年1月至2022年1月进行随访。
方法：回顾性回顾初次接受小梁切开-小梁切除术（CTT）而不使用丝裂霉素C作为初始手术的患者的病历。成功定义为当IOP≥6mmHg和≤21mmHg时，不使用青光眼药物，而当需要两种青光眼药物时，成功定义为完全。需要重新手术以控制IOP的眼睛被认为是故障。使用最大似然估计的混合效应模型用于基于眼睛的变量的估计，并在不同访问之间进行比较。Kaplan-Meier生存分析用于评估手术和功能成功的概率。使用夹心聚类估计的Cox比例风险回归用于评估失败和不良视觉结果的风险因素。
方法：主要结果指标是在20年的随访中显示完全成功的患者比例。次要结果指标包括手术失败率和青光眼需要再次手术，视敏度,屈光不正,不良预后和并发症的危险因素。
结果：Kaplan-Meier生存分析显示1年，10年,20年完成成功率90.7%，78.9%和44.5%,分别。在单变量分析中，在进行任何额外眼内手术的患者中,手术失败率较高.然而,在多变量分析中,没有一项临床参数与失败显著相关.总的来说,眼睛的比例好，正常和不良的视觉结果为33.2％，16.4%和50.4%，分别。近视占68.9%。接受原发性CTT的患者中有28只眼（14.4％）需要进行第二次手术以控制IOP。术中无明显并发症。由于痛苦的失明，六只眼睛需要摘除。
结论：CTT在这一大型PCG患者队列中是一个有用的程序。它提供了良好的IOP控制和适度的视觉恢复，在手术后20年的随访中仍然存在。
