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中华眼科医学杂志(电子版) ›› 2022, Vol. 12 ›› Issue (05) : 275 -280. doi: 10.3877/cma.j.issn.2095-2007.2022.05.004

论著

微导管辅助360°小梁切开术治疗先天性白内障术后继发青光眼的临床研究
王震宇1, 张维嘉2, 胡曼3, 高传文4, 石砚1, 王怀洲1,†()   
  1. 1. 100730　首都医科大学附属北京同仁医院　北京同仁眼科中心　北京市眼科学与视觉科学重点实验室
    2. 100191　北京大学第三医院眼科2022级博士研究生
    3. 100045　国家儿童医学中心　首都医科大学附属北京儿童医院眼科
    4. 450006　河南省暨南大学附属郑州市第二人民医院眼科
  • 收稿日期:2022-09-06 出版日期:2022-10-28
  • 通信作者: 王怀洲
  • 基金资助:
    首都临床特色研究项目(Z161100000516081); 2022年度首都医科大学附属北京同仁医院自然培育基金项目(2021－YJJ－ZZL－040)

The microcatheter-assisted 360° trabeculotomy in the treatment of glaucoma following congenital cataract surgery

Zhenyu Wang1, Weijia Zhang2, Man Hu3, Chuanwen Gao4, Yan Shi1, Huaizhou Wang1,†()   

  1. 1. Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Capital Medical University, Beijing 100730, China
    2. Doctoral degree 2022, Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
    3. National Center for Children′s Health, Department of Ophthalmology, Beijing Children′s Hospital, Beijing 100045, China
    4. Department of Ophthalmology, Zhengzhou Second Hospital, Zhengzhou 450015, China
  • Received:2022-09-06 Published:2022-10-28
  • Corresponding author: Huaizhou Wang
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引用本文：

王震宇, 张维嘉, 胡曼, 高传文, 石砚, 王怀洲. 微导管辅助360°小梁切开术治疗先天性白内障术后继发青光眼的临床研究[J/OL]. 中华眼科医学杂志(电子版), 2022, 12(05): 275-280.

Zhenyu Wang, Weijia Zhang, Man Hu, Chuanwen Gao, Yan Shi, Huaizhou Wang. The microcatheter-assisted 360° trabeculotomy in the treatment of glaucoma following congenital cataract surgery[J/OL]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2022, 12(05): 275-280.

目的

探讨微导管辅助360°小梁切开术治疗先天性白内障术后继发青光眼患者的效果及安全性。

方法

收集2015年4月至2022年2月于首都医科大学附属北京同仁医院眼科中心接受微导管辅助360°小梁切开术的先天性白内障术后继发青光眼患者27例(30只眼)。其中，男性18例(20只眼)，女性9例(10只眼)，年龄8月龄至20岁，平均(6.9±5.9)岁。全部患者行微导管辅助的360°小梁切开术治疗。记录术前及术后1 d、术后1周、术后1个月、术后3个月及术后6个月患者的眼压和需用不同药物的眼数。其中，各时间点患者眼压的检测结果符合正态分布，以(±s)表示，需用药物的眼数以频数和百分比表示。各时间点患者眼压的比较使用单因素重复测量方差分析，各时间点需用药物眼数的比较使用广义估计方程法。计算各时间点的手术总成功率及完全成功率并采用广义估计方程法进行比较。

结果

术前、术后1 d、术后1周、术后1个月、术后3个月及术后6个月的眼压分别为(35.97±7.67)mmHg(1 mmHg＝0.133 kPa)、(14.83±6.54)mmHg、(16.40±5.01)mmHg、(17.90±4.97)mmHg、(17.53±4.13)mmHg及(18.00±3.34)mmHg。术前与术后各时间点患者眼压的总体差异具有统计学意义(F＝92.75，P<0.05)，术前与术后各时间点眼压的差异具有统计学意义(t＝11.49，10.08，9.52，9.87，8.54；P<0.05)，术后各时间点间患者眼压的差异无统计学意义(t＝0.54，1.56，1.21，1.62，0.85，0.78，0.90，0.62，0.47，0.65；P>0.05)。术后1周、术后1个月、术后3个月及术后6个月需用药物0种、1种、2种、3种、4种及5种者分别为19例(22只眼)、3例(3只眼)、1例(1只眼)、2例(2只眼)、2例(2只眼)及0例(0只眼)，18例(20只眼)、3例(3只眼)、2例(2只眼)、3例(3只眼)、2例(2只眼)及0例(0只眼)，18例(20只眼)、4例(4只眼)、2例(2只眼)、3例(3只眼)、1例(1只眼)及0例(0只眼)，17例(19只眼)、4例(4只眼)、1例(1只眼)、5例(5只眼)、1例(1只眼)及0例(0只眼)；分别占73.33%、10.00%、3.33%、6.67%、6.67%及0.00%，66.67%、10.00%、6.67%、10.00%、6.67%及0.00%，66.67%、13.33%、6.67%、10.00%、3.33%及0.00%，63.33%、13.33%、3.33%、16.67%、3.33%及0.00%。术后1周与术后1 d、术后1个月、术后3个月及术后6个月需用药物者的差异具有统计学意义(χ2＝30.26，61.05，55.36，48.86；P<0.05)。术后1个月与术后3个月及术后6个月需用药物者的差异具有统计学意义(χ2＝72.08，76.05；P<0.05)。术后3个月与术后6个月需用药物者的差异具有统计学意义(χ2＝94.80，P<0.05)。全部患者27例(30只眼)中，术后1周、术后1个月、术后3个月及术后6个月的手术基本成功者分别为3例(3只眼)、4例(4只眼)、4例(4只眼)及4例(4只眼)，分别占10.00%、13.33%、13.33%及13.33%；手术完全成功者分别为19例(22只眼)、17例(19只眼)、17例(19只眼)及16例(18只眼)，分别占73.33%、63.33%、63.33%及60.00%。术后各时间点手术完全成功率的差异无统计学意义(χ2＝2.90，P>0.05)。术后1周、术后1个月、术后3个月及术后6个月的手术总成功率分别为83.33%、76.67%、76.67%及73.33%，术后各时间点手术总成功率的差异无统计学意义(χ2＝1.42，P>0.05)。

结论

微导管辅助360°小梁切开术对先天性白内障术后继发青光眼有较好的治疗效果及安全性。

关键词: 先天性白内障术后继发青光眼, 微导管辅助360°小梁切开术, 疗效, 安全性
Objective

To investigate the efficacy and safety of microcatheter-assisted 360° trabeculotomy (MAT) in the treatment of glaucoma following congenital cataract surgery (GFCS).

Methods

From April 2015 to February 2022, 27 patients (30 eyes) with secondary glaucoma after congenital cataract surgery who underwent MAT at the Beijing Tongren Eye Center of Beijing Tongren Hospital affiliated to Capital Medical University were collected. Among them, there were 18 males (20 eyes) and 9 females (10 eyes) with an average age of (6.9±5.9) years (ranged from 8 months to 20 years). All patients were treated with MAT. The intraocular pressure (IOP) and the number of eyes requiring different drugs were recorded before and after operation for 1 day, 1 week, 1 month, 3 months and 6 months. Among them, the IOP of patients at each time point conform to normal distribution and was represented by (±s); the number of eyes requiring medication were represented by cases and percentage. The IOP of patients at each time point was compared using single-factor repeated measurement analysis of variance, and the number of eyes required for medication at each time point was compared using the generalized estimation equation method. The total success rate and complete success rate of the operation at each time point were calculated and compared using the generalized estimation equation method.

Results

The IOP of patients at each time point were (35.97±7.67) mmHg (1 mmHg=0.133 kPa), (14.83±6.54) mmHg, (16.40±5.01) mmHg, (17.90±4.97) mmHg, (17.53±4.13) mmHg and (18.00±3.34) mmHg, respectively. The overall difference of IOP between preoperative and postoperative patients at each time point was statistically significant (F=92.75, P<0.05). The difference of IOP between preoperative and postoperative patients at each time point was statistically significant (t=11.49, 10.08, 9.52, 9.87, 8.54; P<0.05). The difference of IOP between postoperative patients at each time point was not a statistically significant (t=0.54, 1.56, 1.21, 1.62, 0.85, 0.78, 0.90, 0.62, 0.47, 0.65; P>0.05). There were 19 cases (22 eyes), 3 cases (3 eyes), 1 case (1 eye), 2 cases (2 eyes), 2 cases (2 eyes), 0 cases (0 eye), 18 cases (20 eyes), 3 cases (3 eyes), 2 cases (2 eyes) and 3 cases (3 eyes), 2 cases (2 eyes), 0 case (0 eye), 18 cases (20 eyes), 4 cases (4 eyes), 2 cases (2 eyes), 3 cases (3 eyes), and 1 case (1 eye), and 0 case (0 eye) , 17 cases (19 eyes), 4 cases (4 eyes), 1 cases (1 eyes), 5 case (5 eye) and 1 case (1 eye), 0 case (0 eye), accounting for 73.33%, 10.00%, 3.33%, 6.67%, 6.67% and 0.00%, 66.67%, 10.00%, 6.67%, 10.00%, 6.67% and 0.00%, 66.67%, 13.33%, 6.67%, 10.00%, 3.33% and 0.00%, 63.33%, 13.33%, 3.33%, 16.67%, 3.33% and 0.00%, respectively, who used 0, 1, 2, 3, 4, and 5 eyes medications after operation for 1 week, 1 month, 3 months and 6 months. There was a statistically significant difference between them (χ2=30.26, 61.05, 55.36, 48.86; P<0.05). There was a statistically significant difference between the patients who needed drugs after operation for 1 month, 3 months and 6 months (χ2=72.08, 76.05; P<0.05). There was statistically significant difference between those who needed drugs after operation for 3 months and those who needed drugs after operation for 6 months (χ2=94.80, P<0.05). Of the 27 patients (30 eyes), there were 3 patients (3 eyes), 4 patients (4 eyes), 4 patients (4 eyes) and 4 patients (4 eyes) with basically successful operation after 1 week, 1 month, 3 months and 6 months, accounting for 10.00%, 13.33%, 13.33% and 13.33% respectively. The total successful cases were 19 cases (22 eyes), 17 cases (19 eyes), 17 cases (19 eyes) and 16 cases (18 eyes), accounting for 73.33%, 63.33%, 63.33% and 60.00%, respectively. There was not a statistically significant difference in the complete success rate of surgery at each time point (χ2=2.90, P>0.05). The total success rate of operation at each time point was 83.33%, 76.67%, 76.67% and 73.33% respectively. There was not a statistically significant difference in the total success rate of operation at each time point (χ2 =1.42, P>0.05).

Conclusions

MAT is effective and safe in the treatment of GFCS.

Key words: Glaucoma following congenital cataract surgery, Microcatheter-assisted 360°trabeculotomy, Efficacy, Safety
表1 360°小梁切开术治疗术前及术后各时间点患者需用药物眼数的比较[眼数(%)]
时间点 眼数(只眼) 0种药物 1种药物 2种药物 3种药物 4种药物 5种药物
术前 30 1( 3.33) 1( 3.33) 4(13.33) 16(53.33) 6(20.00) 2(6.67)
术后1 d 30 26(86.67) 1( 3.33) 0( 0.00) 3(10.00) 0( 0.00) 0(0.00)
术后1周 30 22(73.33) 3(10.00) 1( 3.33) 2( 6.67) 2( 6.67) 0(0.00)
术后1个月 30 20(66.67) 3(10.00) 2( 6.67) 3(10.00) 2( 6.67) 0(0.00)
术后3个月 30 20(66.67) 4(13.33) 2( 6.67) 3(10.00) 1( 3.33) 0(0.00)
术后6个月 30 19(63.33) 4(13.33) 1( 3.33) 5(16.67) 1( 3.33) 0(0.00)
χ2值       40.06      
P值       <0.05      
图1 微导管辅助360°小梁切开术后各时间点手术成功率的折线图
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