背景:本研究旨在描述在青光眼和角膜混浊的儿科患者中,后置青光眼引流装置(GDD)与同期内窥镜玻璃体切除术的结果。
方法:本回顾性病例系列确定了年龄在18岁以下的患者,这些患者在2012年至2021年期间接受了后位GDD植入并同时进行了内窥镜玻璃体切除术。收集的数据包括眼部诊断,以前的眼内手术,GDD的类型和位置,手术并发症,和额外的手术。术前和最终视力,眼内压(IOP),青光眼药物的数量,和检查结果也被记录。手术数据包括GDD的类型和位置,成功定义为IOP在5-21mmHg之间,没有视觉上破坏性的并发症或需要额外的青光眼手术。
结果:10例(14只眼)硬化角膜(6只),彼得斯异常(4),眼压升高引起的角膜代偿失调(3),和角膜瘢痕(1)接受内镜下玻璃体切除术并向后放置GDD(Baerveldt(10眼),Ahmed(4眼)),年龄为4.6±5.8岁。3例患者的4只眼睛在最后的随访中仍然成功。而7例患者的10只眼需要额外的手术治疗青光眼(7例)或低眼压(3例)。KaplanMeier分析显示1年和2年生存率分别为36%和18%,分别。最终随访(3.7±2.4年),在平均4.4±2.4次青光眼手术后,14只眼中的13只获得了显著较少(p<0.0001)的降低IOP的药物的IOP控制。其他并发症包括视网膜脱离(2),慢性角膜移植失败(2),phthisis(1)和带状角膜病变(1)。
结论:治疗患有角膜混浊的儿童眼青光眼具有挑战性,通常需要多次手术。联合内窥镜玻璃体切除术和后部放置的GDD是建立房水流出的可行技术。虽然成功率很低,这种手术方法可能有助于最终控制这些复杂眼睛的IOP并保持视力.
BACKGROUND: This study aims to describe outcomes of posteriorly-placed glaucoma drainage devices (GDD) with concurrent endoscopic vitrectomy in pediatric patients with glaucoma and corneal opacification.
METHODS: This retrospective case series identified patients under 18 years of age who underwent posteriorly-placed GDD implantation with concurrent endoscopic vitrectomy between 2012 and 2021. Data collected included ocular diagnoses, prior intraocular surgeries, type and position of GDD, surgical complications, and additional surgeries. Preoperative and final visual acuity, intraocular pressure (IOP), number of glaucoma medications, and exam findings were also recorded. Surgical data included type and position of GDD, Success was defined as IOP between 5-21 mmHg without visually devastating complication or need for additional glaucoma surgery.
RESULTS: Ten patients (14 eyes) with
sclerocornea (6), Peters Anomaly (4), corneal decompensation from increased IOP (3), and corneal scar (1) underwent combined endoscopic vitrectomy with posteriorly-placed GDD (Baerveldt (10 eyes), Ahmed (4 eyes)) at 4.6 ± 5.8 years of age. Four eyes of 3 patients remained successful at final follow-up, while 10 eyes of 7 patients required 2.4 ± 1.3 additional surgeries for glaucoma (7) or hypotony (3). Kaplan Meier analysis demonstrated 1- and 2-year survival rates of 36% and 18%, respectively. At final follow-up (3.7 ± 2.4 years), after an average of 4.4 ± 2.4 glaucoma surgeries, 13 of 14 eyes had obtained IOP control on significantly fewer (p<0.0001) IOP-lowering medications. Additional complications included retinal detachment (2), chronic corneal graft failure (2), phthisis (1) and band keratopathy (1).
CONCLUSIONS: Management of glaucoma in pediatric eyes with corneal opacification is challenging and often requires multiple surgeries. A combined endoscopic vitrectomy and posteriorly placed GDD is a viable technique to establish aqueous humor outflow. Although the success rate is low, this surgical approach may be useful in ultimately obtaining IOP control and preserving vision in these complex eyes.