非穿透性小梁切除术治疗开角型青光眼的远期疗效观察

Long-term effect of non-penetrating trabecular surgery in primary open angle glaucoma

目的 观察非穿透性小梁切除术 (non penetratingsurgery ,NPTS)联合透明质酸钠生物胶植入治疗原发性开角型青光眼 (POAG)的远期临床疗效。方法 对 4 1例 5 6眼POAG患者施行NPTS ,观察术后视力、眼压、滤过泡、手术区房角、手术并发症 ,随访 12～ 39个月 ,平均 16 .8个月。结果NPTS术后视力不变或提高 96 .4 3% ,眼压由术前平均(2 5 97± 7.97)mmHg(1kPa =7.5mmHg)降至术后 12个月平均眼压 (19.19± 3 6 6 )mmHg ,差异有显著性 (t=9.4 7,P <0 .0 1)。随访末期眼压≤ 2 1mmHg 31眼 ,需局部用降眼压药后眼压≤ 2 1mmHg 16眼 ,手术失败 8眼。随访末期有功能滤过泡 2 9眼 ,眼压均≤ 2 1mmHg。前房角镜检查 :术后 12个月可见较宽的透明间腔带 4 3眼 ,境界欠清 4眼 ,小梁膜色素沉着、增厚 7眼。 1眼生物胶露出球结膜后行羊膜移植修补。结论 NPTS能有效降低眼压 ,手术并发症少 ,术后视力稳定。手术失败的主要原因是巩膜瓣间、球结膜瘢痕化。

Objective To evaluate the long-term clinical effect of non-penetrati ng surgery (NPTS) with reticulated sodium hyaluronic acid for the treatment of p rimary open angle glaucoma (POAG). Methods NPTS was performed on 56 eyes of 41 patients with POAG. The postoperative data was analyzed along with 12 to 39 months follow-up. Results The postoperative vision of 56 eyes unchanged or somewh at improved.IOP was(25.97±7.97)mmHg before operation,(19.19±3.66)mmHg after op eration(1kPa=7.5mmHg),it was decreased significantly (t=9.47,P<0.01).Within follow-up, the la test IOP was below 21 mmHg in 31 eyes (55.36%),in which 29 eyes had functional b lebs.Sixteen eyes(28.57%)need drug to control IOP,and 8 eyes were failure.The g onioscopy showed a wider transparent cavity at the surgical site in 43 eyes,not enough in 4 eyes,but pigment resorted and incrassation in 7 eyes.The biology pas tern was bared and amnia replanted in 1 eye. Conclusion NTPS procedure is safe,effective and stable in visua l acuity.The reason that was failure is scar of between sclera lamella and bulbe r conjunctiva.