改良小梁切除与传统小梁切除的远期效果观察

Long-term therapeutic efficacy of the reformed trabeculectomy and conventional trabeculectomy

目的评价小梁切除术中改良巩膜瓣、睫状突定量小梁切除、不同缝合方式在术中术后的优缺点及远期效果。方法120例(156眼)原发性青光眼随机分为4组:A组(传统术式组)30例(42眼);B组(可拆褥式缝线组)30例(40眼);C组(L形巩膜瓣小梁切除组)30例(34眼);D组(小切口睫状突定量小梁切除术组)30例(40眼),B,C,D组为改良术式组。比较各组术后浅前房、眼压和滤过泡情况。结果浅前房发生率:A组26.19%(11/42),B组7.50%(3/40),C组2.94%(1/34),D组2.50%(1/40),改良术式组与传统术式组比较差异有统计学意义(P<0.01);随诊眼压:A组(14.65±4.30)mmHg,B组(13.87±3.60)mmHg,C组(15.58±3.20)mmHg,D组(14.50±3.15)mmHg,4组间差异无统计学意义(P>0.05);随诊功能性滤过泡A组76.19%(32/42),B组92.50%(37/40),C组97.05%(33/34),D组95.00%(38/40),传统小梁切除组与改良小梁切除组比较差异有统计学意义(P<0.05)。结论采用巩膜瓣可拆褥式缝线、L形巩膜瓣小梁切除、小切口睫状突定量小梁切除可大大降低术后浅前房的发生率,并能理想地控制眼压,提高术后视功能。

Objective To study the long-term medical efficacy of reformed sclera petal, quantitative trabeculectomy and different suture patterns. Methods 120 cases of primary glaucoma（156 eyes）was randomly divided into four groups. Group A （conventional operation）were 30（42 eyes） ; group B （ removable suture） were 30 （ 34 eyes） ; group D （quantitative trabeculectomy）were 30（40 eyes）,The post-operative anterior chamber, intraocular pressure and the filtration follicles were compared. Results Shallow anteior chamber：group A was 26,19%（11/ 42 ）, group B was 7.50 % （3/40）, group C was 2.94 % （ 1/34 ）, group D was2.50% （!/40）.The intraocular pressure：groukp A was（14,65 ＋ 4.30）mmHg.group B was（13,87 ＋ 3.60）mmHg,group C was（15.58 ＋ 3.20）mmHg,group D was（14.50 ＋ 3.15）mmHg. The functional filtration follicles：group A was 76. 19% （32/42） group B was 92.50% （37/40） group C was 97,05% （33/34） group D was 95.00% （38/40） . Conclusions Reformed trabeculectomy may largely reduce the rate of shallow anterior chamber and may ideally control intraocular pressure and improve visibility function after operation .