改良小梁切除术治疗原发性开角型青光眼的初步报告

A primary report on modified trabeculectomy for primary open angle glaucoma

目的观察改良小梁切除术治疗原发性开角型青光眼的疗效。设计回顾性、病例对照研究。研究对象原发性开角型青光眼患者41例(51眼)。方法本组病例随机分两组。试验组行改良小梁切除术,即切除一垂直巩膜瓣和小梁网,同时做周边虹膜切除和部分球结膜下的筋膜组织切除;对照组行传统小梁切除术。术后随访1年,观察眼压、视力、功能性滤过泡存留情况及并发症,比较两种手术方法的疗效。主要指标眼压、视力、功能性滤过泡及手术并发症。结果术后随访1年,试验组中 97．2％(25／26)的眼压低于21 mmHg,对照组则为76．0％(19／25)。术后最佳矫正视力两组无明显差别。术后两组均未发生严重并发症。结论改良小梁切除术较传统小梁切除术的长期眼压控制好,是治疗开角型青光眼安全有效的手术方式。

Objective To introduce an anti-glaucoma filtering surgery, modified trabeculectomy, which may have a continuous drainage of the aqueous. Design Retrospective, comparative case series. Participants 41 patients （51eyes） with primary open angle glaucoma. Methods Remove a perpendicular scleral flap along with the trabecular meshwork and followed with a peripheral iridectomy and tenonnectomy. The excision of a portion of Tenon＇s capsule ensures that the superior end of the tunnel remains open. Patients were followed over one year period. The therapeutic efficacy of the modified operation versus traditional operation were compared. Main Outcome Measures Pre-and post-operative intraocular pressure（IOP）, un-corrected visual acuity（ UCVA ）, best-corrected visual acuity （BCVA）, postoperative bleb formation and postoperative complications. Results A total of 41 patients （51eyes） were included in this study. Chronic open angle glaucoma was the most common type of glaucoma. During the one year follow-up, 97.2% （25/26） of the mod ified operation treated eyes achieved IOP below 20mmHg and 76.0% （19/25） of traditional operative procedure, below 21mmHg. The postoperative BCVA in both groups did not show significant changes. Conclusion In the modified surgery, a perpendicular sclera strip with trabecular meshwork was excised. Postoperative lOP was reduced and visual acuity remained stable. IOP may be controlled for a long term in modified trap procedure, which seems to be a safer and more effective treatment for open angle glaucoma.