超声生物显微镜检查对非穿透性小梁切除术中羊膜应用价值的探讨

The study of amiotic membrane Implant in non-penetrating trabecular surgery with UBM

目的观察非穿透性小梁切除手术(NPTS)联合MMC及羊膜植入治疗开角型青光眼的远期临床效果,并利用超声生物显微镜(UBM)检查探讨NPTS中应用羊膜的价值。方法对21例(30只眼)28～51岁开角型青光眼患者进行非穿透性小梁手术联合MMC及羊膜植入治疗。术后随访6～18月,观察患者视力、眼压及滤过泡情况,同时利用UBM观察滤过泡的形态、巩膜瓣下形成液间腔的大小、羊膜的转归情况。结果患者术后眼压控制良好,视力较术前无明显变化。患者术前平均眼压与术后平均眼压相比,差异有显著意义(P<0.01)。随访期间有3只眼需药物治疗(10.0%),14只眼有功能性的滤过泡。UBM下所有病例均形成前部的透明液间腔,随访期间,前部巩膜池的形态发生了改变,其边缘逐渐钝化不规则。前部巩膜池的体积都逐渐缩小,差异具有显著性。羊膜在术后9个月左右融解后后部巩膜池无明显透明液间腔存在。结论NPTS联合MMC及羊膜植入能有效降低眼压,远期效果良好。羊膜在NPTS术后中远期无明显的抑制纤维增生、保持滤过畅通的作用,NPTS手术效果可能与羊膜无关。

Objective To evaluate the effect of non-penetrating trabecular surgery （NPTS） with mitomycin C （MMC） and amniotic membrane （AM）implant in patients with primary open-angle glaucoma（ POAG）, to study the role of AM implant in NPTS with ultrasound biomicroscopy （UBM）. Methods NPTS with MMC and AM implant was performed on 30 eyes of 21 patients with POAG aged between 28 - 51 years. Intraocular pressure （IOP） was measured pre-and post-operatively by Goldmann tonometer. Visual acuity and the bleb appearances were recorded. The following factors were observed with UBM, conjunctival bleb appearance, condition of suprascleral aqueous lake and condition of AM. Follow-up from 6 to 18 months after surgery. Results IOP of post-operation was significantly decreased compared with that of pre-operation. At the end of follow-up, IOP was controlled effectively in all patients. Among them, only 3 eyes need anti-glaucoma medication. There was no significant difference in visual acuity between pre-and post-operation. Functional filtering blebs were found in 14 eyes. The margin of anterior aqueous lakes was rough gradually. At 1 - 18months postoperation the valve of anterior aqueous lakes were changed significantly and contracted gradually. Amniotic membrane implant was not degradated until 9 months post-operation and transparent liquid space wasn＇ t formed under the scleral flap. Conclusion NPTS with MMC and AM implant effectively reduced IOP in patients with POAG in long term follow-up. AM was not shown to possess anti-fibrotic properties and facilitate aqueous outflow after NPTS. AM implant did not influence the IOP of post-operation.