羊膜植入治疗难治性青光眼的临床研究

Amniotic membrane transplantation and releasable sutures with trabeculectomy for treatment of refractory glaucoma

目的观察和分析在难治性青光眼手术中羊膜植入的临床效果。方法对入院治疗的连续病例36例(45眼)难治性青光眼,在小梁切除手术中联合羊膜植入并应用可松解缝线技术,术后观察其视力、前房、滤过泡和眼压等情况并进行统计分析。结果手术后平均随访(13.5±6.2)月,随访12月以上者66.67%。手术后6月的39眼平均眼压由术前(42.65±8.40)mmHg降至(17.60±5.16)mmHg,手术总成功率为89.74%;随访12月以上的30眼眼压由术前(41.95±7.18)mmHg降至(19.08±4.81)mmHg,手术总成功率为86.67%;手术前后眼压差异有统计学意义;随访12月以上功能性滤过泡占76.67%。未发现羊膜排斥反应或严重并发症。结论羊膜植入联合小梁切除手术并应用可松解缝线技术是治疗难治性青光眼安全和有效的手术方法。

Objective To observe the effect of trabeculectomy with amniotic membrane transplantation and releasable sutures for treatment of refractory glaucoma. Methods 45 eyes of 36 consecutive patients with refractory glaucoma were received trabeculectomy with amniotic membrane transplantation and releasable sutures. The visual acuity, the intraocular pressure （IOP）, the anterior chamber and the filtering blebs were evaluated and analysed. Results The mean follow-up was 13.5 ±6.2 months.The IOP was lowered from 42.65 ± 8.40 mmHg（preoperative IOP） to postoperative 17.60 ± 5.16 mmHg at 6 months of postoperative, the total success rate was 89.74%;and from 41.95 ± 7.18 mmHg （preoperative IOP） to 19.08 ± 4.81 mmHg at over 12 months,the total success rate was 86.67% . There were significant difference between preoperative and postoperative. The rate of formation of functional filtering bleh （kronfeld types） was 76.67%. There were no reject reaction and severe complication. Conclusions Trabeculectomy with amniotic membrane transplantation and releasable sutures is a useful and safety method for treatment of refractory glaucoma.