Research Of Treatment For Primary Infantile Glaucoma

Objective : To evaluate the therapeutic effect of trabeculotomy associated with trabeculectomy and MMC in the treatment for primary infantile glaucoma.Methods:1.operation: nineteen cases(28eyes)of infantile glaucoma were treated with external trabeculotomy associated with trabeculectomy and MMC.The operation is under general anaesthesia, making superior position conjunctival flap,puting MMC of 0.25-0.333mg/ml under the conjunctival flap,after 4-5minutes,using the PS to wash the conjunctival flap,then make scleral flap of 1/2 thick and 4mm×5mm.In the scleral flap ,find the schlemm canal and radial incision it, then to insert the Harm type trabeculotome and plain scan the trabeculotome on the level direction towards to anterior chamber, same method to cut open another side schlemm canal,and the total scope of opened schlemm canal is 120°. At last make the trabeculectomy to sew up the scleral flap and Tenon and conjunctival flap.At the time of finishing the operation,GM and DM were injected into the subconjunctival. Antibiotics and hormone gutta were used every day after operation.2. acupunctureAcupuncturing the acupoints were used associated with operation for half a year to improve the optic atrophy of infantile glaucoma when these patients have the stable IOP( intraocular pressure).3. train amblyopia and use the redressing mirrorWe supply these operated patients with training amblyopia and redressing mirror in time when they have the stable IOP.Results:1. The result of follow-up:The follow-up ranged from 6 months to 3 years and the average period of follow-up was 24months.2. IOP after operation:Average IOP after operation is 14.15±4.08mmHg, and all IOPs less than 21 mmHg after 7 days. The success rate of the operation was 100%. The IOP of 26 eyes were controlled stably with normal during the follow-up(>6 months). The success rate of the operation was 92. 85%.3. Postoperative complications(1) hyphema The common complication with external trabeculotomy associated with trabeculectomy and MMC was a small amount of hyphema.There are 14 eyes hyphema during the operation.The incidence rate of hyphema is 50%.Among these eyes,4 eyes resorbed within 1day, 7 eyes resorbed within 3days, another 3 eyes resorbed within 1-2weeks.The hyphema was little consequence to the final outcome.(2) shallow of anterior chamber8 eyes appeared with shallow of anterior chamber , incidence rate is 28.57% .4eyes belonging to shallow of anterior chamber I formed anterior chamber after 3 days without treatment . 2 eyes belonging to shallow of anterior chamber II, which were given expectant treatment and formed anterior chamber after 5 days.2 eyes belonging to shallow of anterior chamber III, which were treated additionally with 1-2 adjustable suturation at the two sides of sclerotic flap and infused sodium hyaluronate into anterior chamber under general anaesthesia at the third day and the seventh day respectively.3 days after plasty of anterior chamber,the anterior chamber were formed. The adjustable suture lines could be demolished after coloclysis of chloral hydrate when patients were rechecked 2 weeks later .(3) After the operation,all patients had no ablation chorioidea and macular edema(ME).4. cornea diameter transversa and C/DDiameter transversa of cornea of infantile glaucoma didn't chang after operation .5eyes the C/D of eyes which the tension were well controlled after operation decreased and1 eye which the tension was not controlled after operation decreased.Although the C/D didn't change,but the eyesight decreased.5. Results of traditional Chinese medicine and acupuncture1 case (2 eyes) with stable and low intra-ocular tension were acupunctured Jingming aupoint,Chengqiaupoint,Yangbai aupoint,Taiyang aupoint,Cuanzhu aupoint for half a year to treat optic atrophy induced by glaucoma after trabeculotomy associated with trabeculectomy and MMC. The vision was improved obviously: right eye improved from 0.1 to 0.4, left eye improved from FN/50cm to 0.25.6. Training of amblyopia associated with spectacles of rectification 2 case (4 eyes) with stable and low intra-ocular tension were treated additionally with covering two eyes alternately,amblyopia training and spectacles of rectification after trabeculotomy for half a year after operation.The vision was improved 2 years later in some level: right eye improved from 0.06 to 0.2, left eye improved from 0.1 to 0.4 in one case.In another case,the parents said that the vision of the patient had improved obviously the patient was incompatible to checking vision after wearing spectacles of rectification 1 year.Conclusions:1. The treatment of extrernal trabeculotomy associated with trabeculectomy and application of MMC under conjunctival flap is at a high achievement rate ,and the postoperative complications of which are less , soft and relieved easily. The achievement rate at discharge is 100%,and 92.85% after following up.2. The IOP is low and stable after operation,and the vision could be improved associated with acupuncture.3. The IOP is low and stable after operation,and the vision could be improved if patient correct vision , wearing spectacles.