直线巩膜隧道切口可拆除缝线小梁切除术

Straight Scleral Tunnel Insicion-Trabeculectomy with One Releasabel Suture

目的探讨直线巩膜隧道切口可拆除缝线小梁切除术联合丝裂霉素 C(mytomycin C,MMC)的疗效和并发症。方法将同期连续原发性闭角型青光患者分为:A 组:直线巩膜隧道切口可拆除缝线小梁切除术+MMC 眼98例(128眼);B 组:可拆除缝线小梁切除术+MMC 71例(95眼);C 组:小梁切除术+MMC 48例(60眼)。比较3组疗效和并发症。结果 3组术后1年手术成功率无统计学差异。浅前房和低眼压:A、B 组无统计学差异,但都低于 C 组;高眼压和脉络膜脱离3组间无统计学差异。术后角膜散光量:A 组术后2 wk 增高不明显(P=0.187,P>0.05),术后1年时接近术前水平;B、C 组术后2 wk 明显增高,术后1年时仍明显高于术前(P=0.001,P<0.01)。术后角膜极向散光值:3组术后早期明显增高,出院后逐渐下降。结论直线巩膜隧道切口可拆除缝线小梁切除术+MMC 与另两种术式相比,疗效相当,但术性角膜散光较小,3种术式都可以引起顺规性散光,随着时间延长,向逆规性散光漂移。可拆除缝线的应用有利于减少术后早期并发症。

Purose The study was designed to describe a modified technique,cobmined with mitomycin C(MMC) straight scleral tunnel incision-trabeculectomy with releasable suture and evaluate its efficacy and complications in the patients with primary angle-closure glaucoma(PACG).Methods Group A 128 eyes of 98 consecutive patients underwent straight scleral tunnel insicion-trabeculectomy with one releasable suture supplemented with MMC,Group B 95 eyes of 71 consecutive patients underwent releasable suture trabeculectomy with MMC,Group C 60 eyes of 48 consecutive patients underwent trabeculectomy with MMC,IOP,complications and surgically induced astigmatism(SIA)were evaluated preoperatively and up to 12 months postoperatively.Results The differences of complete success rate between the three groups were not significant after 12 months postoperatively.The incidence of shallow anterior chamber and hypotony were not significantly different between Group A and B.But beth were lower than that in Group C respectively.The incidence of hypertony and choroidal detachmdent were not significantly different between the three groups.The increase of mean astigmatism was not significant after 2 weeks in Group A(P=0.187,P>0.05).After 12 monthes the astigmatism almost returned to preoperative levels. The increases of mean astigmatism were significant after 2 weeks in Group B and C.After 12 months the mean astigmatism in Group B and C were still more than before operation(P=0.001,P<0.01).The increases of mean astigmatic polar values in three Groups were significant during early postoperative period.Then they decreased gradually.Conclusion Straight scleral tunnel insicion-trabeculectomy with one releasable suture supplemented with MMC appears to be equivalent to releasable suture trabeculcctomy with MMC and trabeculectomy with MMC in lowering the IOP of patients with PACG.But its SIA was lowerest in the three groups.SIA in the three groups showed with-the-rule change and followed against-the-rule astigmatic shift up to 12 months postoperatively.Using releasable suture technique can reduce the incidence of complications during the early postoperative period.