childhood glaucoma

儿童青光眼
  • 文章类型: Journal Article
    目的:探讨儿童青光眼患者的长期视力转归和低视力相关因素。
    方法:对2005年至2023年在OndokuzMayís大学眼科诊所的小儿青光眼患者的病历进行了回顾性审查。患者分为三组:原发性先天性青光眼(PCG),继发性儿童青光眼,白内障手术(GFCS)后的青光眼。各组进行视力(VA)分析,眼部疾病和合并症,和视力障碍的原因。该研究还调查了与视力障碍相关的潜在危险因素。
    结果:共纳入60例患者的105只眼,平均年龄9.7±5.5岁。logMAR的平均VA为0.59±0.52。在最后的后续行动中,34.1%有良好的VA(≥20/50),29.5%有中度VA(20/50-20/200),36.4%的患者VA较差(<20/200)。最终平均眼内压(IOP)为16.2±6.2mmHg。弱视是视力丧失的主要原因(38.2%),其次是青光眼损害(36.4%)。GFCS患者的视力障碍和屈光不正发生率较高(42.4%)。回归分析结果显示,低视力与接受两次以上手术有关,基线高IOP,高初始和最终杯盘比(C/D),和较高的初始中央角膜厚度(CCT)(CI95%,分别为p=0.018、p=0.017、p=0.013、p=0.003、p=0.001)。
    结论:34.1%的儿童青光眼患者可以获得良好的VA。然而,GFCS患者VA预后可能更差.在儿童青光眼中实现良好的视力结果需要及时有效的治疗,考虑风险因素,弱视和眼合并症的治疗。
    OBJECTIVE: To investigate long-term visual outcomes and factors associated with low vision in patients with childhood glaucoma.
    METHODS: A retrospective review was conducted on the medical records of pediatric glaucoma patients at the Ondokuz Mayıs University Ophthalmology Clinic from 2005 to 2023. The patients were categorized into three groups: primary congenital glaucoma (PCG), secondary childhood glaucoma, and glaucoma following cataract surgery (GFCS). Groups were analyzed regarding visual acuity (VA), ocular conditions and comorbidities, and the cause of visual impairment. The study also investigated the potential risk factors associated with visual impairment.
    RESULTS: A total of 105 eyes of 60 patients with a mean age of 9.7 ± 5.5 years were included in the study. The mean VA in logMAR was 0.59 ± 0.52. At the final follow-up, 34.1% had good VA (≥ 20/50), 29.5% had moderate VA (20/50-20/200), and 36.4% had poor VA (< 20/200). The final mean intraocular pressure (IOP) was 16.2 ± 6.2 mmHg. Amblyopia was the leading cause of vision loss (38.2%), followed by glaucomatous damage (36.4%). Patients with GFCS had a higher rate of visual impairment (42.4%) and refractive error. The results of the regression analysis showed that low vision was associated with undergoing more than two surgeries, high IOP at baseline, high initial and final cup-to-disc (C/D) ratio, and high initial central corneal thickness (CCT) (CI 95%, p = 0.018, p= 0.017, p = 0.013, p = 0.003,  p = 0.001, respectively).
    CONCLUSIONS: Good VA can be achieved in 34.1% of childhood glaucoma cases. However, the VA prognosis may be worse in patients with GFCS. Achieving good visual outcomes in childhood glaucoma requires timely and effective treatment, consideration of risk factors, and management of amblyopia and ocular comorbidities.
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  • 文章类型: Journal Article
    儿童青光眼是一组异质性的眼部疾病,定义为从出生到18岁的发病年龄。这些威胁视力的疾病需要早期诊断,及时治疗,和终身管理,以保持视力和尽量减少不可逆转的失明。儿童青光眼的遗传学具有表型和遗传异质性。这篇综述的目的是总结不同类型的儿童青光眼及其遗传结构,以帮助患者及其家人进行遗传咨询。我们提供了相关综合征的概述,并讨论了遗传咨询的含义,包括基因检测策略,级联基因检测,和生殖选择。
    Childhood glaucoma is a heterogeneous group of ocular disorders defined by an age of onset from birth to 18 years. These vision-threatening disorders require early diagnosis, timely treatment, and lifelong management to maintain vision and minimise irreversible blindness. The genetics of childhood glaucoma is complex with both phenotypic and genetic heterogeneity. The purpose of this review is to summarise the different types of childhood glaucoma and their genetic architecture to aid in the genetic counselling process with patients and their families. We provide an overview of associated syndromes and discuss implications for genetic counselling, including genetic testing strategies, cascade genetic testing, and reproductive options.
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  • 文章类型: Journal Article
    目的:探讨日本人群CYP1B1和FOXC1基因突变的频率和位置。
    方法:分子遗传学分析。
    方法:从29个家庭的31名日本儿童青光眼(CG)患者中提取基因组DNA。我们检查了CYP1B,FOXC1和MYOC基因使用Sanger测序和全外显子组测序(WES)。
    结果:对于CYP1B1,我们鉴定出了9个带有新突变的家族,p.A202T,p.D274E,p.Q340*,和p.V420G;其余突变先前已报道。当映射到CYP1B1蛋白结构时,所有突变似乎都通过引起结构畸形来影响CYP1B1的酶活性。5例患者为纯合子或复合杂合子,支持CG中CYP1B1突变的隐性遗传。相比之下,4例患者为CYP1B1突变杂合,提示调节区突变或强修饰的存在。对于FOXC1基因,我们发现了3个新的突变,p.Q23fs,p.Q70R,和p.E163*,所有这些都是在杂合状态下鉴定的。在这些CG患者中未发现MYOC基因突变。所有具有CYP1B1和FOXC1突变的个体均受到早发性CG的严重影响。在CYP1B1-中,FOXC1-,和MYOC阴性家庭,我们还搜索了通过WES报道的其他CG候选基因的变异,但是在这些基因中找不到任何突变。
    结论:我们对29个CG家族的分析揭示了9个家族在CYP1B1基因中存在点突变,其中四名患者似乎是杂合子,提示存在复杂的致病机制。FOXC1似乎是CG的另一个主要致病基因,表明CYP1B1和FOXC1的组测序将有助于日本个体的CG诊断。
    OBJECTIVE: To explore the frequency and positions of genetic mutations in CYP1B1 and FOXC1 in a Japanese population.
    METHODS: Molecular genetic analysis.
    METHODS: Genomic DNA was extracted from 31 Japanese patients with childhood glaucoma (CG) from 29 families. We examined the CYP1B, FOXC1, and MYOC genes using Sanger sequencing and whole-exome sequencing (WES).
    RESULTS: For CYP1B1, we identified 9 families that harbored novel mutations, p.A202T, p.D274E, p.Q340*, and p.V420G; the remaining mutations had been previously reported. When mapped to the CYP1B1 protein structure, all mutations appeared to influence the enzymatic activity of CYP1B1 by provoking structural deformity. Five patients were homozygotes or compound heterozygotes, supporting the recessive inheritance of the CYP1B1 mutations in CG. In contrast, four patients were heterozygous for the CYP1B1 mutation, suggesting the presence of regulatory region mutations or strong modifiers. For the FOXC1 gene, we identified 3 novel mutations, p.Q23fs, p.Q70R, and p.E163*, all of which were identified in a heterozygous state. No mutation was found in the MYOC gene in these CG patients. All individuals with CYP1B1 and FOXC1 mutations were severely affected by early-onset CG. In the CYP1B1-, FOXC1-, and MYOC-negative families, we also searched for variants in the other candidate genes reported for CG through WES, but could not find any mutations in these genes.
    CONCLUSIONS: Our analyses of 29 CG families revealed 9 families with point mutations in the CYP1B1 gene, and four of those patients appeared to be heterozygotes, suggesting the presence of complex pathogenic mechanisms. FOXC1 appears to be another major causal gene of CG, indicating that panel sequencing of CYP1B1 and FOXC1 will be useful for diagnosis of CG in Japanese individuals.
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  • 文章类型: Journal Article
    目的:比较先天性风疹综合征(CRS)患儿与非风疹性白内障患儿婴儿期白内障术后继发性青光眼的发生率,并探讨相关危险因素。
    方法:回顾性病例对照研究。
    方法:纳入婴儿期接受白内障手术的CRS患儿和因婴儿白内障而接受白内障手术的年龄匹配的婴儿。
    方法:比较两组的青光眼发生率和生存概率。评估青光眼发展的危险因素。最低随访时间为白内障术后1年。
    结果:该研究包括115名儿童的211只眼。CRS组(病例)101眼(58例儿童),非风疹性白内障组(对照)110眼(57例儿童)。两组之间的手术平均年龄没有显着差异(p=0.96)。在整个14年的研究期间,CRS组为32.7%,对照组为24.5%(p=0.19)。CRS组的平均随访时间为5.8±3.7年,非风疹组的平均随访时间为6.4±3.4年。白内障手术后10年无青光眼生存的累积概率存在显着差异(病例0.53与对照组0.8;log秩p-0.034)。两组在继发性青光眼的发病时间上无显著性差异,降低眼压药物的平均数量和手术治疗青光眼的眼睛数量(p>0.05)。在CRS眼中,微角膜与青光眼的发展有关(风险比2.83,95%置信区间1.44-5.57;p=0.002)。
    结论:与接受婴儿白内障手术的婴儿相比,患有CRS的婴儿进行白内障手术后继发性青光眼的发生率没有显着差异。由于CRS患儿无青光眼生存的十年概率明显较低,建议进行更近距离和更长时间的随访,尤其是在具有高危特征的眼睛中.
    OBJECTIVE: To compare the incidence of secondary glaucoma after cataract surgery performed in infancy in children with congenital rubella syndrome (CRS) and children with nonrubella cataracts and to identify associated risk factors.
    METHODS: Retrospective case control study.
    METHODS: Children with CRS who had undergone cataract surgery in infancy and age-matched infants who had undergone cataract surgery for infantile cataracts were included.
    METHODS: Incidence of glaucoma and probability of survival was compared among the 2 groups.
    METHODS: Risk factors for the development of glaucoma were assessed. The minimum follow-up was 1 year after cataract surgery.
    RESULTS: The study included 211 eyes of 115 children. The CRS group (cases) had 101 eyes (58 children) and the nonrubella cataract group (controls) included 110 eyes (57 children). There was no significant difference in the mean age at surgery among the 2 groups (P = 0.96). Cumulative incidence of secondary childhood glaucoma for the entire study period of 14 years was 32.7% in the CRS group and 24.5% in the control group (P = 0.19). Mean follow-up was 5.8 ± 3.7 years for CRS group and 6.4 ± 3.4 years for the nonrubella group. A significant difference in the cumulative probability of glaucoma free survival at 10 years after cataract surgery (cases 0.53 vs controls 0.8; log rank P = 0.034) was present. Both groups had no significant difference in the time of onset of secondary glaucoma, average number of intraocular pressure lowering medications and number of eyes with surgical intervention for glaucoma (P > 0.05). Microcornea was associated with the development of glaucoma (hazard ratio 2.83; 95% confidence interval, 1.44-5.57; P = 0.002) in CRS eyes.
    CONCLUSIONS: There was no significant difference in the incidence of secondary glaucoma after cataract surgery performed in infants with CRS compared with infants who had undergone surgery for infantile cataracts. Because the 10-year probability of glaucoma free survival was significantly less in children with CRS, a closer and longer follow-up is recommended especially in eyes with at-risk features.
    BACKGROUND: The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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  • 文章类型: Journal Article
    原发性先天性青光眼(PCG)是一种具有挑战性的诊断条件,治疗和有效监测。眼内压(IOP)的系列评估,视神经盘拔罐,折射,手术后的轴向长度(AxL)可用于评估疾病控制。这项研究旨在评估PCG患儿青光眼手术后AxL变化与IOP变化的关系。
    我们回顾性研究了接受手术的PCG患儿的AxL变化。纳入了在2014年6月至2018年7月期间随访期间未接受过眼科手术且至少接受过一次青光眼手术的≤4岁儿童的眼睛。使用线性混合效应模型估计IOP变化对AxL变化的影响。
    共有105只眼(72例儿童)的PCG患者接受了青光眼手术,占26.4%(105/397)的眼睛。基线儿童的平均±SD年龄为3.53±4.04个月。在基线,平均眼压和AxL分别为26.63±9.57mmHg和21.67±1.82mm,分别。在手术后的随访过程中,眼压平均下降7.25±12.08mmHg,AxL平均上升0.70±1.40mm。多变量混合效应线性回归显示,AxL的变化与IOP的变化(p=0.030)和首次手术后的时间(p<0.001)显着相关。术后3个月需要大幅降低IOP(≥35mmHg),让AxL回归。
    在接受青光眼手术的PCG儿童中,眼压的变化显著影响AxL的变化。为了让AxL回归,手术后需要大幅降低IOP.
    UNASSIGNED: Primary congenital glaucoma (PCG) is a challenging condition to diagnose, treat and effectively monitor. Serial assessment of intraocular pressure (IOP), optic disc cupping, refraction, and axial length (AxL) after surgery are useful to assess disease control. This study aimed to evaluate AxL changes in relation to IOP changes following glaucoma surgery in children with PCG.
    UNASSIGNED: We retrospectively studied AxL changes in children with PCG undergoing surgery. Eyes of children aged ≤ 4 years that did not have prior ocular surgery and that underwent at least one glaucoma surgery during the course of follow-up between June 2014 and July 2018, were included. The effect of change in IOP on change in AxL was estimated using linear mixed effects models.
    UNASSIGNED: A total of 105 eyes (of 72 children) with PCG underwent glaucoma surgery representing 26.4% (105/397) eyes. The mean ± SD age of children at baseline was 3.53 ± 4.04 months. At baseline, the mean IOP and AxL were 26.63 ± 9.57 mmHg and 21.67 ± 1.82 mm, respectively. During the course of follow-up post-surgery, the IOP decreased by a mean of 7.25 ± 12.08 mmHg while the AxL increased by a mean of 0.70 ± 1.40 mm. A multivariable mixed effects linear regression revealed that change in AxL was significantly associated with change in IOP (p=0.030) and time since first surgery (p<0.001). A substantial reduction in IOP (≥35 mmHg) was needed at 3 months post-surgery, for AxL to regress.
    UNASSIGNED: In children with PCG who undergo glaucoma surgery, change in IOP significantly influences change in AxL. For AxL to regress, a substantial reduction in IOP is needed post-surgery.
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  • 文章类型: Journal Article
    儿童青光眼(CG)包括一组异质性的遗传性眼病,约占全球儿童失明的5%。了解分子病因是提高诊断的关键,预后和解锁优化临床管理的潜力。在这项研究中,我们调查了来自78个不同种族背景的无关家庭的86例CG病例,招募到基因组英格兰100,000基因组计划(GE100KGP)罕见疾病队列,以提高基因诊断产量。使用基因组英格兰/基因组医学中心(GE/GMC)诊断管道,解决了13个无关家庭(13/78,17%)。使用扩展的基因小组进行进一步的询问在另外7个无关的家族中产生了分子诊断(7/78,9%)。该分析有效地将GE100KGP中解决的CG家族的总数提高到26%(20/78家族)。25%(5/20)的解决家庭患有原发性先天性青光眼(PCG),而75%(15/20)患有继发性CG;该组中有53%患有非获得性眼部异常(包括虹膜发育不全,巨角膜,伞状异位,视网膜营养不良,和屈光不正)和47%的人患有非获得性全身性疾病,例如心脏异常,听力障碍,和发育迟缓。CYP1B1是最常见的基因,占解决家庭的55%(11/20)。我们在TEK基因中发现了两种新的可能的致病变异,除了FOXC1中的一个新的致病性拷贝数变异体(CNV)。在GE100KGP诊断管道中未检测到的变体可能是由于分层过程的限制,在分析过程中使用较小的基因面板,以及编码SNV和indel相对于较大结构变体的优先级,CNVs,和非编码变体。
    Childhood glaucoma (CG) encompasses a heterogeneous group of genetic eye disorders that is responsible for approximately 5% of childhood blindness worldwide. Understanding the molecular aetiology is key to improving diagnosis, prognosis and unlocking the potential for optimising clinical management. In this study, we investigated 86 CG cases from 78 unrelated families of diverse ethnic backgrounds, recruited into the Genomics England 100,000 Genomes Project (GE100KGP) rare disease cohort, to improve the genetic diagnostic yield. Using the Genomics England/Genomic Medicine Centres (GE/GMC) diagnostic pipeline, 13 unrelated families were solved (13/78, 17%). Further interrogation using an expanded gene panel yielded a molecular diagnosis in 7 more unrelated families (7/78, 9%). This analysis effectively raises the total number of solved CG families in the GE100KGP to 26% (20/78 families). Twenty-five percent (5/20) of the solved families had primary congenital glaucoma (PCG), while 75% (15/20) had secondary CG; 53% of this group had non-acquired ocular anomalies (including iris hypoplasia, megalocornea, ectopia pupillae, retinal dystrophy, and refractive errors) and 47% had non-acquired systemic diseases such as cardiac abnormalities, hearing impairment, and developmental delay. CYP1B1 was the most frequently implicated gene, accounting for 55% (11/20) of the solved families. We identified two novel likely pathogenic variants in the TEK gene, in addition to one novel pathogenic copy number variant (CNV) in FOXC1. Variants that passed undetected in the GE100KGP diagnostic pipeline were likely due to limitations of the tiering process, the use of smaller gene panels during analysis, and the prioritisation of coding SNVs and indels over larger structural variants, CNVs, and non-coding variants.
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  • 文章类型: Journal Article
    儿童青光眼,全球失明的重要原因,代表分类为原发性或继发性形式的一组异质性疾病。原发性儿童青光眼是最常见的亚型,包括原发性先天性青光眼(PCG)和青少年开角型青光眼(JOAG)。目前,多种基因与遗传形式的原发性儿童青光眼有关。这篇全面的综述深入研究了原发性儿童青光眼的遗传研究,专注于识别致病基因,了解他们的继承模式,探索疾病发病机理中必不可少的生物学途径,并利用动物模型研究这些机制。具体来说,注意力集中在CYP1B1(细胞色素P450家族1亚家族B成员1)等基因上,LTBP2(潜伏转化生长因子β结合蛋白2),TEK(TEK受体酪氨酸激酶),ANGPT1(血管生成素1),和FOXC1(叉头箱C1),全部与PCG相关;和MYOC(肌蛋白),与JOAG有关。通过探索这些遗传因素,这篇综述旨在加深我们对原发性儿童青光眼复杂发病机制的理解,从而促进发展增强的诊断和治疗策略。
    Childhood glaucoma, a significant cause of global blindness, represents a heterogeneous group of disorders categorized into primary or secondary forms. Primary childhood glaucoma stands as the most prevalent subtype, comprising primary congenital glaucoma (PCG) and juvenile open-angle glaucoma (JOAG). Presently, multiple genes are implicated in inherited forms of primary childhood glaucoma. This comprehensive review delves into genetic investigations into primary childhood glaucoma, with a focus on identifying causative genes, understanding their inheritance patterns, exploring essential biological pathways in disease pathogenesis, and utilizing animal models to study these mechanisms. Specifically, attention is directed towards genes such as CYP1B1 (cytochrome P450 family 1 subfamily B member 1), LTBP2 (latent transforming growth factor beta binding protein 2), TEK (TEK receptor tyrosine kinase), ANGPT1 (angiopoietin 1), and FOXC1 (forkhead box C1), all associated with PCG; and MYOC (myocilin), associated with JOAG. Through exploring these genetic factors, this review aims to deepen our understanding of the intricate pathogenesis of primary childhood glaucoma, thereby facilitating the development of enhanced diagnostic and therapeutic strategies.
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  • 文章类型: Journal Article
    目的:为了评估质量,可读性,大型语言模型(LLM)生成的儿童青光眼患者教育材料(PEM)的准确性,以及他们提高现有在线信息可读性的能力。
    方法:横断面比较研究。
    方法:我们评估了ChatGPT-3.5,ChatGPT-4和Bard对三个不同提示的反应,要求他们在儿童青光眼上写PEM。普通美国人很容易理解“提示A要求的PEM”。使用简单的Gobbledygook(SMOG)可读性公式在6年级水平上编写“提示B要求的PEM”。“然后我们比较了回答的质量(DISCERN问卷,患者教育材料评估工具(PEMAT)),可读性(SMOG,Flesch-Kincaid分级等级(FKGL)),和准确性(李克特错误信息量表)。为了评估现有在线信息可读性的提高,提示C要求LLM从Google搜索关键字“儿童青光眼”到美国医学会推荐的“六年级”的20个资源。“对重写进行了关键指标的比较,如可读性,复杂单词(≥3个音节),和句子计数。
    结果:所有3个LLM生成的PEM都是高质量的,可理解性,和准确性(DISCERN≥4,PEMAT可理解性≥70%,错误信息得分=1)。对于所有3个LLM,提示B响应比提示A响应更具可读性(p≤0.001)。与ChatGPT-3.5和Bard相比,ChatGPT-4生成了最易读的PEM(p≤0.001)。尽管提示C反应显示平均SMOG和FKGL得分一致降低,只有ChatGPT-4达到指定的6级阅读水平(分别为4.8±0.8和3.7±1.9)。
    结论:LLM可以作为生成高质量的强大补充工具,准确,和新颖的PEM,并提高现有PEM对儿童青光眼的可读性。
    OBJECTIVE: To evaluate the quality, readability, and accuracy of large language model (LLM)-generated patient education materials (PEMs) on childhood glaucoma, and their ability to improve existing the readability of online information.
    METHODS: Cross-sectional comparative study.
    METHODS: We evaluated responses of ChatGPT-3.5, ChatGPT-4, and Bard to 3 separate prompts requesting that they write PEMs on \"childhood glaucoma.\" Prompt A required PEMs be \"easily understandable by the average American.\" Prompt B required that PEMs be written \"at a 6th-grade level using Simple Measure of Gobbledygook (SMOG) readability formula.\" We then compared responses\' quality (DISCERN questionnaire, Patient Education Materials Assessment Tool [PEMAT]), readability (SMOG, Flesch-Kincaid Grade Level [FKGL]), and accuracy (Likert Misinformation scale). To assess the improvement of readability for existing online information, Prompt C requested that LLM rewrite 20 resources from a Google search of keyword \"childhood glaucoma\" to the American Medical Association-recommended \"6th-grade level.\" Rewrites were compared on key metrics such as readability, complex words (≥3 syllables), and sentence count.
    RESULTS: All 3 LLMs generated PEMs that were of high quality, understandability, and accuracy (DISCERN ≥4, ≥70% PEMAT understandability, Misinformation score = 1). Prompt B responses were more readable than Prompt A responses for all 3 LLM (P ≤ .001). ChatGPT-4 generated the most readable PEMs compared to ChatGPT-3.5 and Bard (P ≤ .001). Although Prompt C responses showed consistent reduction of mean SMOG and FKGL scores, only ChatGPT-4 achieved the specified 6th-grade reading level (4.8 ± 0.8 and 3.7 ± 1.9, respectively).
    CONCLUSIONS: LLMs can serve as strong supplemental tools in generating high-quality, accurate, and novel PEMs, and improving the readability of existing PEMs on childhood glaucoma.
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  • 文章类型: Journal Article
    目的:比较微脉冲激光(MP-TSCP)与二极管激光慢凝经巩膜睫状体光凝(TSCP)对难治性儿童青光眼(CG)患者降低眼压(IOP)的安全性和有效性。
    方法:纳入了CG患者和至少12个月的病历数据。对术前和术后结果数据进行分析。主要结果是眼压为6-21mmHg和/或基线值降低≥20%。
    结果:共纳入17只眼。MP-TSCP术前平均IOP为28mmHg,TSCP术前平均IOP为29.9mmHg。MP-TSCP中的平均IOP显着降低至17.26±3.27mmHg,最后一次病历中的平均IOP降低至14.68±5.79mmHg。两组术前均对眼睛给予三种抗青光眼药物。向MP-TSCP施用平均1.02滴眼液,向TSCP施用平均2.06滴眼液。MP-TSCP中的药物数量减少了2.38±1.55,TSCP中的药物数量减少了0.82±1.68。MP-TSCP的术前视力中位数(logMAR)为1.51±1.06,TSCP为1.87±0.74。MP-TSCP的平均视敏度(logMAR)变化为-0.027±0.05,TSCP为-0.40±0.58。最常见的并发症是角膜代偿失调(1-MP-TSCP和2-TSCP)。
    结论:这两种技术对降低眼压均有效且相对安全。这些技术似乎扩展了CG眼中睫状体光凝术的适应症并改善了功能预后。
    OBJECTIVE: To compare the safety and efficacy of micropulse laser (MP-TSCP) and slow coagulation transscleral cyclophotocoagulation (TSCP) with a diode laser for reducing intraocular pressure (IOP) in patients with refractory childhood glaucoma (CG).
    METHODS: Patients with CG and at least 12 months of medical chart data were included. Data on preoperative and postoperative outcomes were analyzed. The primary outcomes were an IOP of 6-21 mmHg and/or ≥ 20% reduction in the baseline value.
    RESULTS: A total of 17 eyes were included. The preoperative mean IOP was 28 mmHg in the MP-TSCP and 29.9 mmHg in the TSCP. The mean IOP decreased significantly to 17.26 ± 3.27 mmHg in the MP-TSCP and 14.68 ± 5.79 mmHg TSCP at the last medical record. Three anti-glaucoma meds were administered to the eyes preoperatively in both groups. A mean of 1.02 eye drops was administered to the MP-TSCP and 2.06 to the TSCP. The number of medications decreased by 2.38 ± 1.55 in the MP-TSCP and 0.82 ± 1.68 in the TSCP. The median preoperative visual acuity (logMAR) was 1.51 ± 1.06 in the MP-TSCP and 1.87 ± 0.74 in the TSCP. The variation in mean visual acuity (logMAR) was -0.027 ± 0.05 in the MP-TSCP and -0.40 ± 0.58 in the TSCP. The most frequent complication was corneal decompensation (one - MP-TSCP and two - TSCP).
    CONCLUSIONS: Both techniques were effective and relatively safe for reducing IOP. These techniques appear to extend the indications of cyclophotocoagulation in CG eyes and improve the functional prognosis.
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  • 文章类型: Journal Article
    目的:确定患者报告的结局指标(PROMs),已经用于患有青光眼的儿童和青少年,并评估其方法学质量。
    结论:儿童青光眼在生命的所有阶段都会损害视力和生活质量。因此,PROM需要涵盖许多不同的年龄组和主题。各种仪器已被用于评估儿童青光眼患者的患者报告结果,然而,尚不清楚哪种PROM具有最高的方法学质量,并且最符合儿童青光眼患者的需求.
    方法:搜索MEDLINE(PubMed),科克伦图书馆,WebofScienceandPsycINFO(EBSCO)。我们用英语收录了同行评审的过去十年的全文文章,德语或西班牙语在青光眼儿童中报告了PROM。确定的PROM的研究选择和方法学质量评估由两名独立的审阅者使用七点检查表进行。内容被映射到世界卫生组织国际功能分类,残疾与健康。系统评价在PROSPERO(IDCRD42022353936)中进行了前瞻性注册。
    结果:检索到的搜索策略符合3295项。筛选了2901项研究,使用十种不同的工具确定了11篇相关文章。仪器解决了功能视觉能力(FVA),视觉相关生活质量(VRQoL),健康相关QoL(HRQoL),生活满意度(LS)。六种仪器适用于儿童。七份问卷获得的正面评分最高(5/7)。这些仪器都没有考虑到儿童青光眼患者在发育过程中的观点。
    结论:本系统综述提供了用于儿童青光眼队列的特定视力和通用健康PRO仪器的描述性目录。缺乏专门为儿童青光眼开发的仪器,这可能会导致缺少重要因素,例如用滴眼液进行永久性治疗,重复的手术和疾病的遗传性,在调查青光眼儿童的生活质量时。
    OBJECTIVE: To identify patient-reported outcome measures (PROMs) that have been used in children and adolescents with glaucoma and to evaluate their methodologic quality.
    CONCLUSIONS: Childhood glaucoma impairs vision and quality of life (QoL) throughout all stages of life. Thus, a PROM needs to cover many different age groups and topics. Various instruments have been used to evaluate patient-reported outcomes (PROs) in patients with childhood glaucoma, however, it is unclear which PROM has the highest methodologic quality and complies best with the needs of patients with childhood glaucoma.
    METHODS: A systematic literature review was performed searching MEDLINE (PubMed), the Cochrane Library, Web of Science, and PsycINFO (EBSCO). We included peer-reviewed full-text articles of the past 10 years in English, German, or Spanish language that reported PROMs in children with glaucoma. The study selection and methodologic quality assessment of the identified PROMs was performed by 2 independent reviewers using a 7-point checklist. The content was mapped onto the World Health Organization International Classification of Functioning, Disability and Health. The systematic review was prospectively registered in PROSPERO (ID CRD42022353936).
    RESULTS: The search strategy retrieved 3295 matches. A total of 2901 studies were screened, and 11 relevant articles were identified using 10 different instruments. The instruments addressed functional visual ability, vision-related QoL, health-related QoL, and life satisfaction. Six instruments were applicable for the use in children. Seven of the questionnaires received the highest number of positive ratings (5/7). None of the instruments considered the views of patients with childhood glaucoma during their development.
    CONCLUSIONS: This systematic review provides a descriptive catalog of vision-specific and generic health PRO instruments that have been used in childhood glaucoma cohorts. An instrument specifically developed for childhood glaucoma is lacking which might result in missing important factors, such as permanent treatment with eye drops, repeated surgeries, and heritability of the disease, when investigating the QoL in children with glaucoma.
    BACKGROUND: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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