1Department of Ophthalmology, Zhengzhou Children's Hospital, Children's Hospital of Henan Province,Zhengzhou University Affiliated Children's Hospital, Zhengzhou 450000, China
2Henan Eye Hospital, Henan Eye Institute, the People's Hospital of Henan Province, Zhengzhou 450000,China
Abstract：Objective: To investigate the clinical efficacy of ab externo microcatheter-assisted trabeculotomy (MAT) in childhood glaucoma and the open range of the incised trabecular meshwork one year after surgery. Methods: This was a prospective clinical study. 21 patients (28 eyes) with childhood glaucoma, aged 4-16 years, were enrolled in the glaucoma center of Henan Eye Hospital from January 2018 to December 2019. All patients underwent ab externo MAT. Patients were followed up for one year after surgery. The best corrected visual acuity (BCVA), intraocular pressure (IOP), usage of anti-glaucoma medication, the condition of the anterior chamber angle and complications were observed and analyzed. A paired t test, Wilcoxon signed-rank test, Kruskal-Wallis H test, and Spearman rank correlation were used to analyze the data. Results: All patients underwent ab externo MAT successfully. Surgery on 16 patients (22 eyes) was performed with full incisions and surgery on 5 patients (6 eyes) was performed with a subtotal incision. Preoperative BCVA (median: 0.8, range: 0.00-2.00) was not significantly different from postoperative BCVA (median: 0.75, range: 0.00-1.60) (Z=-1.41, P=0.157). Preoperative and postoperative IOPs were 30.4±4.8 mmHg (1 mmHg=0.133 kPa) and 14.1±4.5 mmHg, respectively. The difference was statistically significant (t=14.11, P<0.001). The amount of the postoperative anti-glaucoma medication (median: 0, range: 0-3) was significantly lower than preoperative levels (median: 3, range: 1-4) (Z=-4.35, P<0.001). At the last follow-up, the open range of the incised trabecular meshwork median was 302.5° (range: 70°- 360°). Fifteen cases (21 eyes) and 4 cases (5 eyes) achieved complete and qualified success; 2 cases (2 eyes) failed. The open range medians of the incised trabecular meshwork of the 3 groups were 330°(210°- 360°), 205°(180°-225°), and 85°(70°-100°) at the last visit. The open ranges of the different groups were statistically significant (χ2=15.20, P=0.001). The open range of incised trabecular meshwork was negatively correlated with intraocular pressure (r=-0.82, P<0.001). Conclusions: Ab externo MAT is effective for treating childhood glaucoma,and the postoperative open range of the incised trabecular meshwork is an important factor affecting the prognosis for children.
Dragosloveanu CDM, Celea CG, Dragosloveanu ?. Comparison of 360° circumferential trabeculotomy and conventional trabeculotomy in primary pediatric glaucoma surgery: complications, reinterventions and preoperative predictive risk factors. Int Ophthalmol, 2020, 40(12): 3547-3554. DOI: 10.1007/s10792-020-01544-9.
[2]
Morales J, Al Shahwan S, Al Odhayb S, et al. Current surgical options for the management of pediatric glaucoma. J Ophthalmol, 2013, 2013: 763735. DOI: 10. 1155/2013/763735.
[3]
Lim ME, Neely DE, Wang J, et al. Comparison of 360-degree versus traditional trabeculotomy in pediatric glaucoma. J AAPOS, 2015, 19(2): 145-149. DOI: 10.1016/j.jaapos.2015.01. 008.
[4]
Girkin CA, Marchase N, Cogen MS. Circumferential trabeculotomy with an illuminated microcatheter in congenital glaucomas. J Glaucoma, 2012, 21(3): 160-163. DOI: 10.1097/ IJG.0b013e31822af350.
[5]
Girkin CA, Rhodes L, McGwin G, et al. Goniotomy versus circumferential trabeculotomy with an illuminated microcatheter in congenital glaucoma. J AAPOS, 2012, 16(5): 424-427. DOI: 10.1016/j.jaapos.2012.05.013.
[6]
Shi Y, Wang HZ, Yin J, et al. Microcatheter-assisted trabeculotomy versus rigid probe trabeculotomy in childhood glaucoma. Br J Ophthalmol, 2016, 100(9): 1257-1262. DOI: 10.1136/bjophthalmol-2015-307880.
[7]
Temkar S, Gupta S, Sihota R, et al. Illuminated microcatheter circumferential trabeculotomy versus combined trabeculotomytrabeculectomy for primary congenital glaucoma: a randomized controlled trial. Am J Ophthalmol, 2015, 159(3): 490-497.e2. DOI: 10.1016/j.ajo.2014.12.001.
[8]
Mendicino ME, Lynch MG, Drack A, et al. Long-term surgical and visual outcomes in primary congenital glaucoma: 360 degrees trabeculotomy versus goniotomy. J AAPOS, 2000, 4(4): 205-210. DOI: 10.1067/mpa.2000.106201.
Barkan O. Pathogenesis of congenital glaucoma: gonioscopic and anatomic observation of the angle of the anterior chamber in the normal eye and in congenital glaucoma. Am J Ophthalmol, 1955, 40(1): 1-11. DOI: 10.1016/0002-9394(55)92114-0.
[13]
魏文斌, 施玉英. 眼科手术操作与技巧. 北京: 人民卫生出版 社, 2011: 174-180.
[14]
Sarkisian SR Jr. An illuminated microcatheter for 360-degree trabeculotomy [corrected] in congenital glaucoma: a retrospective case series. J AAPOS, 2010, 14(5): 412-416. DOI: 10.1016/j.jaapos.2010.07.010.
[15]
Shi Y, Wang H, Yin J, et al. Outcomes of microcatheter-assisted trabeculotomy following failed angle surgeries in primary congenital glaucoma. Eye (Lond), 2017, 31(1): 132-139. DOI: 10.1038/eye.2016.212.
[16]
El Sayed Y, Gawdat G. Two-year results of microcatheterassisted trabeculotomy in paediatric glaucoma: a randomized controlled study. Acta Ophthalmol, 2017, 95(8): e713-e719. DOI: 10.1111/aos.13414.
[17]
Hu M, Wang HZ, Huang AS, et al. Microcatheter-assisted trabeculotomy for primary congenital glaucoma after failed glaucoma surgeries. J Glaucoma, 2019, 28(1): 1-6. DOI: 10.1097/IJG.0000000000001116.
Alanazi FF, Song JC, Mousa A, et al. Primary and secondary congenital glaucoma: baseline features from a registry at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. Am J Ophthalmol, 2013, 155(5): 882-889. DOI: 10.1016/ j.ajo.2012.12.006.
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