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OA

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.