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原發性先天性青光眼接受小樑網切開術由不同的異常隅角發生來探討手術的結果
Trabeculotomy Ab Externo in Primary Congenital Glaucoma with the Different Trabeculodysgenesis by Gonioscopy
摘要
在原發性先天性青光眼的外科手術中小樑網切開術是一種安全且有效的手術。本文報告自民國六十八年七月至民國七十八年七月十年間，發病年齡在三歲以前的原發性先天性青光眼且第一次手術即接受小樑網切開術，共有四十五名病例六十隻眼睛，平均發病年齡是10.1±7.4個月，平均追踪病程時間是38.5±27.8個月。依照隅角鏡檢查的結果將不正常葡萄膜組織附著在小樑網上的位置前後分為兩種型態Ta及Tb type，進而探討這兩種異常隅角發生型態經過小樑網切開術手術後成功率是否有所不同，結果顯示這兩種型態其成功率相近並沒有統計上差異(Ta: Tb=83.9%: 82.8%)。本文並討論一些可能影響手術結果因素：如手術前的角膜直徑大小、眼壓及視神經盤凹陷的比值，和診斷及接受手術的年齡大小等。最後討論手術後發生視神經盤凹陷回復的機會及可能影響的因素。
關鍵字
無資料並列摘要
Trabeculotomy ab externo is reported to be a very safe and effective operation in cases of primary congenital glaucoma. We reviewed 60 eyes in 45 cases of primary congenital glaucoma (onset before the age of 3 years), 36 eyes in 27 males and 24 eyes in 18 females, treated with first operation with trabeculotomy ab externo from July 1979 to July 1989. The age ranged from 2 to 30 months, with an average of 10.1±7.4 months. The duration of follow-up period ranged from 3 to 120 months, with the mean of 38.5±27.8 months. Under the criteria of success for controlling lop below 20 mmHg and no progressive cupping of disc without any anti-glaucoma medication, we had successfully treated 50 of the 60 eyes (83.3%). According to the different findings of gonioscopy in primany congenital glaucoma, two type of the trabeculodysgenesis were classified; Ta: abnormal uveal meshwork inserted anteriorly to the scleral spur, Tb: abnormal uveal meshwork inserted at or posteriorly to the scleral spur. We made the comparison between two types in successful rate (Ta: 26/31: 83.9%, Tb: 24/2 9: 82.8%) and reverse-cupping rate (Ta: 15/26: 57.7%, Tb: 15/24: 62.5%). Finally we d-is-cussed the probable influencing factors in the success of trabeculotomy ab externo including the corneal size and IOP of pre-operation, time of operation and surgical complications in two different trabeculodysgenesis of patients.