报告30年来对色素性血管瘤病(PPV)患者进行青光眼治疗的临床结果。
回顾性队列研究。
在1990年1月至2019年12月期间,在一家机构管理了38例(21例单侧和17例双侧)PPV青光眼患者的55只眼,最少随访1年。
回顾了PPV青光眼患儿的医疗记录,收集人口统计学和临床数据。手术干预包括原发性小梁切开-小梁切除术(CTT),丝裂霉素C(MMC)小梁切除术,和经巩膜睫状体光凝(TSCPC)。完全成功定义为不使用药物的眼内压(IOP)≥6和≤16mmHg,并且使用多达2种药物的IOP≤16mmHg的合格成功。
眼内压,最佳矫正视力(BCVA),角膜透明度,术前和术后访视(最后一次访视)时的抗青光眼药物,和并发症。
年龄中位数为4个月(范围,0.2-252个月)在青光眼手术时。39只眼睛(74%)患有原发性CTT,10眼(19%)进行了MMC小梁切除术,4眼(7%)晚期青光眼有TSCPC。两只眼睛(3.6%)接受了治疗。术前IOP从0.8±0.6药物的平均25.7±8.4mmHg降至术后末次随访(77.7±56.5个月)的0.4±0.5药物的14.6±5.2mmHg(P<0.0001)。37眼(67.3%)术前需要药物治疗,22只眼睛(40%)在最后一次随访时需要药物治疗.在最后一次随访的25例患者中,9人(36%)≥20/60;其中,6>20/40。接受MMC小梁切除术的10只眼睛中有4只发生视网膜脱离,并通过手术治疗;然而,所有这些眼睛的视力都很差.没有发生气泡渗漏,大泡相关性感染,或眼内炎。
联合小梁切开术-小梁切除术作为治疗PPV青光眼的主要方法是安全有效的。以MMC作为第二次手术的小梁切除术与更高的并发症发生率相关。
To report the clinical outcomes of glaucoma management in patients with phacomatosis pigmentovascularis (PPV) treated over a period of 3 decades.
Retrospective cohort study.
Fifty-five eyes of 38 patients (21 unilateral and 17 bilateral) with glaucoma in PPV managed at one institution between January 1990 and December 2019 with a minimum follow-up of 1 year.
Medical records of children with glaucoma in PPV were reviewed, and demographic and clinical data were collected. Surgical interventions included primary combined trabeculotomy-trabeculectomy (CTT), trabeculectomy with mitomycin C (MMC), and transscleral cyclophotocoagulation (TSCPC). Complete success was defined as intraocular pressure (IOP) ≥ 6 and ≤ 16 mmHg without medications and qualified success as IOP ≤ 16 mmHg with the use of up to 2 medications.
Intraocular pressure, best-corrected visual acuity (BCVA), corneal clarity, antiglaucoma medications at preoperative and postoperative visits (last visit), and complications.
Median age was 4 months (range, 0.2-252 months) at the time of glaucoma surgery. Thirty-nine eyes (74%) had primary CTT, 10 eyes (19%) had trabeculectomy with MMC, and 4 eyes (7%) with advanced glaucoma had TSCPC. Two eyes (3.6%) received medical treatment. Preoperative IOP reduced from a mean of 25.7 ± 8.4 mmHg on 0.8 ± 0.6 medications to 14.6 ± 5.2 mmHg on 0.4 ± 0.5 medications (P < 0.0001) at last follow-up after surgery (77.7 ± 56.5 months). Thirty-seven eyes (67.3%) required medications preoperatively, and 22 eyes (40%) required medications at the last follow-up. Of 25 patients with available BCVA at last follow-up, 9 (36%) had ≥ 20/60; of these, 6 had > 20/40. Four of 10 eyes that underwent trabeculectomy with MMC developed retinal detachment and were managed surgically; however, all of these eyes had poor visual outcomes. There was no incidence of bleb leakage, bleb-related infection, or endophthalmitis.
Combined trabeculotomy-trabeculectomy is safe and effective as a primary procedure for management of glaucoma in PPV. Trabeculectomy augmented with MMC as a second procedure was associated with a higher rate of complications.