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在闭角型青光眼中的应用

Mitomycin C "straight scleral tunnel insicion"-trabeculectomy with one releasable suture to treat angle-closure glaucoma

目的:将直线巩膜隧道切口应用于可拆除缝线小梁切除术联合丝裂霉素C(mytomycinC,MMC)治疗闭角型青光眼,探讨其疗效和并发症。方法:将同期连续原发性闭角型青光眼患者分为:A组:直线巩膜隧道切口可拆除缝线小梁切除术+MMC,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年手术成功率差异无显著性。浅前房和低眼压:A、B组差异无显著性,但都低于C组;高眼压和脉络膜脱离3组间差异无显著性。术后角膜散光量:A组术后2周增高不明显(P>0.1),术后1年时接近术前水平;B、C组术后2周明显增高,术后1年时仍明显高于术前(P<0.005)。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。可拆除缝线技术的应用有利于减少术后早期并发症。

Objective:To describe a modified technique, 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:One hundred and twenty-eight eyes of 98 consecutive patients underwent'straight scleral tunnel insicion'-trabeculectomy with one releasable suture supplemented with MMC(Group A). Ninety-five eyes of 71 consecutive patients underwent releasable suture trabeculectomy with MMC(Group B). Sixty eyes of 48 consecutive patients underwent trabeculectomy with MMC(Group C). IOP, complications and surgically induced astigmatism(SIA) were evaluated preoperatively and up to 12 months postoperatively. Results:The differences of complete success rate between 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 both them were lower than that in Group C respectively. The incidence of hypertony and choroidal detachment was not significantly different between three groups. The increase of mean astigmatism was not significant after 2 weeks in Group A(P > 0.1). By 12 months the astigmatism almost returned to preoperative levels. The increases of mean astigmatism were significant after 2 weeks in Group B and C. By 12 months the mean astigmatism in Group B and C were still more than before operation(P < 0.005). 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 trabeculectomy with MMC and trabeculectomy with MMC in lowering the IOP of patients with PACG. But its SIA was lowerest in three groups. SIA in 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.