青光眼黏弹剂小管扩张术的临床疗效观察及Schlemm管直径测量

Clinical observation of glaucoma viscocanalostomy and the diameter measure of Schlemm’s tube

目的评价青光眼黏弹剂小管扩张术的安全性和有效性,探讨Schlemm管直径的测量方法。方法收集21例31眼青光眼(开角和慢闭)行黏弹剂小管扩张术及Schlemm管直径测量(NPTS组)的临床资料,总结和分析患者的眼压、视力、眼内反应、滤过泡及手术并发症的发生情况,以及Schlemm管直径测量情况,并与青光眼经典小梁切除手术(PTS组)20例33眼青光眼(开角和慢闭)进行比较。术后随访时间至少6月。结果术后6月,NPTS组平均眼压为(10.44±3.88)mmHg(1mmHg=0.133kPa),较术前降低(24±15.78)mmHg,差异有显著意义(P=0.000);术后1周、1月、6月两组降眼压效果比较,差异无显著意义(P=0.959,0.986,0.884)。Schlemm管直径测量结果为0.39～0.63mm,平均(0.50±0.07)mm。NPTS组术后视力均无下降;PTS组术后视力8眼下降。NPTS组术中并发症包括小梁网Descement膜小穿孔5眼,术后滤过泡漏1眼,3只眼有轻微房水闪辉2～3d消失外无任何眼内反应。PTS组术后并发症包括浅前房、前房出血各4只眼,前房出血3-7d消失;术后15眼有轻微房水闪辉,2-6d消失;脉脱2眼,滤过泡漏1眼,并发性白内障2眼。结论青光眼黏弹剂小管扩张术效果好、并发症少,可安全、有效治疗开角性和部分慢性闭角型青光眼。Schlemm管直径测量方法可行。

Objective To evaluate the therapeutic effects and safety of viscocanalostomy （NPTS） and trabeculectomy （PTS）. Methods Viscocanalostomy and the diameter measure of Schlemm＇s tube was performed in 31 eyes of 21 glaucoma patients with primary open-angle and close-angle. Results Follow-up was performed up to 6 months after surgery. The mean intraocular pressure （lOP） of （NPTS） group was （10.44 ± 3.88）mmHg （lmmHg=0.133kPa） with a mean pressure reduction of 24 ± 15.78mmHg compared with lOP before the operation （P=0.000）. There were no statistical defferences of the lOP within two groups during postoperative 1 week, 1 and 6 month （P=0.959, 0.986, 0.884）. The diameter measure of Schlemm＇s tube ranges from 0.39mm to 0.63 mm and a mean is （0.50 ± 0.07） mm. Complications of NPTS group is Descemet＇s membrane puncture 5 eyes, There were no flare and cells in the anterior chamber in 28 eyes. In 3 eyes there was only slight flare that disappeared in 2-3 days. The NPTS group showed a significantly less inflammation, hyphema and choroidal detachment than in the PTS group. Conclusions Viscocanalostomy is a safe and efficacious surgery lower complications. The technique of the diameter measure of Schlemm＇s tube is practicable.