目的:评价微导管辅助小梁切开术(MAT)治疗先天性白内障术后继发性青光眼的疗效,并探讨其与不同程度小梁切开术的相关性。
方法:对2019年9月至2020年9月接受上述手术的患者进行回顾性分析。根据小梁切开术的程度将患者分为两组(第1组:≤240度;第2组:240-360度)。随访12个月,收集患者手术前后眼压(IOP)及抗青光眼药物。
结果:共纳入25例患者的27只眼:1组11只眼(40.7%),2组16只眼(59.3%)。所有患者术前平均眼压分别为34.67±9.18mmHg和8.74±4.32、9.95±5.65、14.39±5.30、16.02±4.37、15.82±3.28和16.19±3.56mmHg。1wk,手术后1、3、6和12mo,分别。在所有患者中,各时间点眼压差异有统计学意义(F=65.614,P<0.01)。在每一组中,术后眼压低于术前(均P<0.01),但两组间IOP降低率无差异(P=0.246)。此外,术后12mo抗青光眼药物用量由术前的2.63±0.49(2-3)降至0.30±0.67(0-2)(P<0.01),两组比较差异无统计学意义(P>0.05)。在后续行动结束时,第1组的部分成功率为81.8%,第2组的部分成功率为93.75%(P=0.549)。术中和术后各眼均出现不同数量的前房积血,通过穿刺和灌溉自发吸收或清洁。无其他严重并发症发生。
结论:MAT能有效降低先天性白内障术后继发性青光眼患者的眼压,成功率高,安全性好。可作为先天性白内障术后继发性青光眼的首选治疗方法。
OBJECTIVE: To evaluate efficacy of microcatheter-assisted trabeculotomy (MAT) in eyes with secondary glaucoma after congenital cataract surgery and explore its correlation with the different degree of trabeculotomy.
METHODS: A retrospective analysis was conducted on patients who underwent the said procedure between September 2019 and September 2020. The patients were classified into two groups according to the degree of trabeculotomy (group 1: ≤240-degree; group 2: 240-360-degree). The intraocular pressure (IOP) and anti-glaucoma drugs before and after operation was collected during the 12-month follow-up.
RESULTS: Totally 27 eyes of 25 patients were included: 11 (40.7%) eyes in group 1 and 16 (59.3%) eyes in group 2. The mean IOP of all patients was 34.67±9.18 mm Hg preoperatively and 8.74±4.32, 9.95±5.65, 14.39±5.30, 16.02±4.37, 15.82±3.28, and 16.19±3.56 mm Hg 1d, 1wk, 1, 3, 6, and 12mo after surgery, respectively. In all patients, there were significant differences in IOP at each time point (F=65.614, P<0.01). In each group, IOP after surgery was lower than that before surgery (all P<0.01), but there was no difference in the rate of IOP reduction between the two groups (P=0.246). Furthermore, the amount of anti-glaucoma medications reduced to 0.30±0.67 (0-2) at 12mo from 2.63±0.49 (2-3) preoperatively (P<0.01), and there was no difference between the two groups (P>0.05). At the end of follow-up, the partial success rate was 81.8% in group 1 vs 93.75% in group 2 (P=0.549). Various amount of intraoperative and postoperative hyphema occurred in all eyes, which spontaneously absorbed or cleaned through paracentesis and irrigation. No other serious complications was observed.
CONCLUSIONS: MAT can effectively reduce IOP in patients with secondary glaucoma after congenital cataract surgery with a high success rate and safety. And it can be used as the first choice for the treatment of secondary glaucoma after surgery for congenital cataracts.