眼科学报2026，Vol.41Issue(4)：325-332,8.DOI:10.12419/25020802
CO2激光辅助深层巩膜切除术治疗GATT术后失败的儿童难治性青光眼:病例报告与文献回顾
CO2 laser-assisted deep sclerectomy for childhood refractory glaucoma following failed GATT surgery:case report and literature review
摘要
Abstract
Objective:To present a case of refractory pediatric glaucoma that was successfully managed using carbon dioxide laser-assisted deep sclerectomy(CLASS)after gonioscopy-assisted transluminal trabeculotomy(GATT)failed.Additionally,it seeks to analyze the etiological factors contributing to postoperative intraocular pressure(IOP)elevation and review the current surgical strategies for pediatric refractory glaucoma.Methods:This case report details the clinical management of a 3-year-and-5-month-old male child with bilateral congenital glaucoma who had previously undergone trabeculectomy.The patient developed persistent IOP elevation following bilateral cataract surgery with intraocular lens implantation.Conservative treatment methods proved ineffective,leading to sequential GATT procedures.Although the IOP in the left eye stabilized after the GATT procedure,the right eye continued to exhibit refractory hypertension,despite the presence of patent anterior chamber angles on gonioscopy(with only minimal peripheral anterior synechiae observed).Subsequently,a CLASS procedure was performed on the right eye,with systematic monitoring of postoperative IOP changes and assessment of the scleral lake condition.Results:Over the 36-month follow-up period,the right eye maintained stable IOP levels(ranging from 16 to 20 mmHg)without any surgical complications or the need for antihypertensive medications.At the 2-month and 3-year postoperative follow-up visits,anterior segment optical coherence tomography(AS-OCT)and ultrasound biomicroscopy(UBM)revealed the presence of a well-formed scleral lake.Conclusions:The incidence of elevated IOP following cataract surgery is notably high in pediatric patients with glaucoma.When IOP remains uncontrolled after GATT,the choice of reoperation warrants careful consideration.In this case,the application of CLASS for refractory pediatric glaucoma with uncontrolled IOP after GATT achieved favorable outcomes,offering a new therapeutic approach for such patients.关键词
儿童难治性青光眼/深层巩膜切除术/房角镜辅助小梁切开术/眼压/超声生物显微镜Key words
pediatric refractory glaucoma/deep sclerectomy/gonioscopy-assisted transluminal trabeculotomy/intraocular pressure/ultrasound biomicroscopy分类
医药卫生引用本文复制引用
范罕英,何宇,荆琳,曾流芝..CO2激光辅助深层巩膜切除术治疗GATT术后失败的儿童难治性青光眼:病例报告与文献回顾[J].眼科学报,2026,41(4):325-332,8.基金项目
成都市卫生健康委员会立项课题(2020007).This work was supported by the Project of Chengdu Municipal Health Commission(2020007). （2020007）
