| ObjectiveTo observe the early efficacy of trabeculectomy combined with incision of outer wall of Schlemm’s canal in the treatment of juvenile glaucoma.MethodsThe clinical and follow up data of 102 eyes of 79 cases with juvenile glaucoma from Sep.2017 to Sep.2019 in the First Affilated Hospital of Zhengzhou University First were retrospectively analyzed.All cases were randomly divided into two groups according to the random number table method.Group A,51 eyes of 39 cases,underwent trabeculectomy combined with incision of outer wall of Schlemm’s canal.Group B,51 eyes of 40 cases,underwent trabeculectomy.All patients underwent a comprehensive ophthalmological examination and systemic examination.The patients were followed up for 6 months.The visual acuity(logMAR),intraocular pressure,the MD value of visual field,the average RNFL thickness,application of intraocular pressure-lowering drugs,filtering blebs and complications before and after the operation were compared and analyzed between two groups.Results(1)The visual acuity,the MD value of visual field and the average RNFL thickness of the two groups A and B at 6 months after operation was not significantly changed compared with that before operation,and the differences were not statistically significant(P>0.05).The total surgical success rate of the two groups A and B at 6 months after operation was not significantly diffference,and the differences were not statistically significant(χ~2=1.77,P=0.18).(2)The postoperative intraocular pressure of the two groups A and B at any observation points was significantly lower than that before operation,and the differences were statistically significant(P<0.05).The difference in intraocular pressure between the two groups at 1 day after operation was not statistically significant(t=-1.10,P=0.28).The differences in intraocular pressure between the two groups at 1 week,1 month,3 months,and 6 months after operation were statistically significant(P<0.05).The preoperative intraocular pressure in group A and B were(31.61±12.40)mm Hg and(29.82±8.81)mm Hg(1mm Hg= 0.133k Pa)respectively,there was no significant difference(t=0.93,P=0.36). During the following time,the intraocular pressure increased in 8 eyes(15.69%) in Group A.After the application of local postoperative massage or combined application of intraocular pressure-lowering drugs,the postoperative intraocular pressure reduced to the normal range(≤21mm Hg)in 7 eyes(13.73%).1 eye (1.96%)underwent filtration bubble ablation again.The intraocular pressure increased in 11 eyes(21.57%)in Group B.After the application of local postoperative massage or combined application of intraocular pressure-lowering drugs,the postoperative intraocular pressure reduced to the normal range(≤21mm Hg)in 8 eyes(15.69%).3 eyes(5.88%)underwent filtration bubble ablation again.(3)The intraocular pressure-lowering drugs of the two groups A and B at 6 months after operation was significantly reduced compared with those before operation, and the differences were statistically significant(t=14.31,P=0.00;t=15.17, P=0.00).The intraocular pressure-lowering drugs in group A and B were(2.31± 0.71)and(2.04±0.75)respectively,and the difference was not statistically significant(t=1.96,P=0.06).(4)Functional filtering blebs were formed in 40 eyes(78.43%)in Group A. neffective filtering blebs were formed in 11 eyes(21.57%)in Group A.Among hem,the intraocular pressure of 6 eyes(11.77%)with ineffective filtering blebs ere still controlled in normal range.Functional filtering blebs were formed 36 yes(70.59%)in Group B postoperatively.Ineffective filtering blebs were ormed in 15 eyes(29.41%)in Group B.Among them,the intraocular pressure f 5 eyes(9.80%)with ineffective filtering blebs were still controlled in normal ange.(5)Intraoperative and postoperative complications:hyphema occurred in 8 eyes 15.69%)in Group A and 2 eyes(3.92%)in Group B.The shallow anterior hamber appeared in 6 eyes(11.77%)in Group A and 12 eyes(25.33%)in Group .No serious complication such as suprachoroidal hemorrhage,hypotensive acular edema or endophthalmitis occurred in two groups A and B during and fter surgery.ConclusionTrabeculectomy combined with incision outer wall of Schlemm’s canal is one of the safe and effective surgical treatment methods for juvenile glaucoma. |
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