难治性青光眼用两种术式治疗的远期疗效分析

Compare long-term effects of two different modus operandi on refractory glaucoma

目的观察比较两种手术方式(小梁切除术+虹膜根切术;脉络膜上腔引流术)治疗难治性青光眼的临床远期疗效。方法回顾性分析2002年2月至2006年1月我院收治的难治性青光眼共87例(91只眼),应用脉络膜上腔引流术治疗37例(37只眼),应用小梁切除+虹膜根切术治疗50例(54只眼)。手术成功的判定标准:不用或仅局部应用抗青光眼药物,眼压控制在5～21 mmHg(1 mmHg=0.133 kPa)之间,且视力稳定、角膜透明者视为手术成功。结果随访时间均在1年以上,平均随访(34.3±13.7)个月。末次随访经脉络膜上腔引流术治疗组成功30只眼(81.1%);经小梁切除+虹膜根切术治疗组成功32只眼(59.3%)。两组手术成功率差异有显著性(X^2=4.815,P<0.05)。应用脉络膜上腔引流术治疗组手术成功率高。结论长期随访观察及临床研究显示脉络膜上腔引流术较小梁切除+虹膜根切术设计合理,手术成功率高,并发症少,远期疗效好。

Objective To evaluate the long-erm effectiveness of aqueous fluid internal drainage operation from epichoroidal spaces and trabeculectomy add iridectomy on refractory glaucoma. Methods 87cases（91eyes） diagnosised refractory glaucoma between 2002 and 2006 were studied. 37cases （ 37eyes ） were treated with epichoroidal spaces drainage , 50cases （ 54eyes） were treated with trabeculectomy add iridectomy. Definitions of successful operation were determined as （ 1 ） intraocular pressure （IOP） were controlled between 5mmHg and 21mmHg with vision improved or no descented and clear corneal. （ 2 ） no anti-glaucoma medication or only local medication of topical anti-laucoma drops. Results All cases were followed-up for over 1year, the mean followed-p time was （ 37.3 ± 13.7 ） months. According the last follow-p, 30 eyes （ 81.1% ） were successful in the epichoroidal spaces drainage group; 32 eyes （ 59.3% ） were successful in the trabeculectomy add iridectomy group. Statistical significant difference （ χ^2=4. 815 , P 〈 0.05 ） was found in the success rate between these 2 groups. Conclusion Long-erm observations have confirmed that epichoroidal spaces drainage had a higher success rate and fewer complications than trabeculectomy add iridectomy during the follow-up time.