可调节巩膜缝线小梁切除术的临床疗效

Clinical Significance of Removable Scleral-flap Suture During Trabeculectomy

目的观察可调节巩膜缝线小梁切除术治疗原发性闭角性青光眼的临床疗效。方法以我院2000年5月～2002年5月收治的首次接受滤过手术治疗的原发性闭角性青光眼79例(91只眼)为对象,随机分为两组,其中39例(48只眼)进行标准小梁切除术,40例(43只眼)进行可调节巩膜缝线小梁切除术,并在术后根据眼压水平、前房情况、滤过泡形态适时拆除巩膜缝线,于术后第2d、1周、1月、3月、1年检查并比较两组的眼压、滤过泡、前房情况、视力。结果两种术式都可以有效地控制眼压;进行巩膜调节缝线组患者术后浅前房、低眼压的发生均低于标准术式组,差异均有显著性(P<0.025)。结论两种手术方式对眼压的远期疗效无明显差异,但在早期可调节巩膜缝线小梁切除术可有效地减少术后超滤过引起的浅前房和低眼压等并发症,增强了手术的安全性。

Objective To evaluate the effect of removable scleral-flap suture during trabeculectomy in treatment of primary angle-closure glaucoma. Methods Seventy-nine patients(91 eyes) with primary angle-closure Glaucoma from May, 2000 to May, 2002 in our hospital were accepted trabeculectomy initially, and were randomly divided into two groups. The first group (39 patients,48 eyes) received standard trabeculectomy; the second group(40 patients, 43 eyes) received the trabeculectomy with removable scleral-flap suture, and the sclera suture would be removed according to the intraocular pressure, the condition of the anterior chamber and the filtrative cyst. The intraocular pressure, the filtrative cyst ,the anterior chamber and the visual acuity of both groups were tested during the second day, the first week, the first one month, the third month, and one year after the operation. Results Both metheds can control the intraoclar pressure effectively. The incidences of adverse reactions in the second group was lesser than the first group, such as shallow anterior chamber, intraocular hypopressure, hemorrhage in the anterior chamber (hyphema), detachment of choroids and hypotonous maculopathy and the difference showed statistical significance (P<0.025). Conclusion The effects of controlling intraocular pressure by both methods are similar; during the early postoperative stage, the trabeculectomy with removable scleral-flap suture can effectively minimize the complications, however, such as shallow anterior chamber and intraocular hypotension, which can enhance the safety of trabeculectomy.