超声生物显微镜在非穿透小梁手术后随访的意义

UBM in postoperative follow-up for glaucoma after NPTS.

目的观察非穿透性小梁手术联合MMC及羊膜植入治疗开角型青光眼的远期临床效果,研究超声生物显微镜(UBM)在非穿透小梁切除术后随访的意义。方法对21例(30眼)开角型青光眼进行非穿透小梁手术联合MMC及羊膜植入术治疗,术后观察视力、眼压及滤过泡情况。分别在术后1,3,6,9,12,18月,利用UBM观察滤过泡的形态、巩膜瓣下形成液间腔的大小、剩余小梁膜的厚度及羊膜的变化。结果患者术后眼压控制良好,手术前后眼压相比,差异有统计学意义(P<0.01)。UBM下所有病例均形成前部的透明液间腔。随访期间巩膜池前部体积无明显变化,平均宽(1.936±0.516)mm,高(0.285±0.117)mm;薄层小梁网组织平均厚度为(0.128±0.057)mm,且随访期间厚度基本无改变。羊膜在术后9月左右融解后后部巩膜池无明显透明液间腔存在。结论非穿透性小梁手术联合MMC及羊膜植入能有效地降低眼压,远期效果良好。UBM适合于非穿透性小梁切除术的长期随访。

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 assess the validity of Ultrasound biomicro-scopy（UBM） in postoperative follow-up of cases with NPTS.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）,visual acuity and the bleb appearances were recorded.UBM of the sclerectomy site was performed 1,3,6,9,12,and 18 months after surgery.The following parameters were assessed： conjunctival bleb appearance,condition of suprascleral aqueous lake,and the thickness of residual trabeculocorneal membrane and condition of amniotic membrane.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.There was no significant difference in visual acuity between pre-and post-operation.After surgery UBM showed that anterior suprascleral aqueous lakes（3.20 ±0.91 mm in length,0.65±0.71 mm in height）and trabeculo-corneal membranes（0.65±0.71mm in thickness） in different size were observed in all of eyes.The area of aqueous lakes and thickness of membranes were not changed significantly.The superficial choroidal detachment wasn＇t observed with UBM in all cases.Amniotic membrane implant wasn＇t degradated until 9 months post-operation and transparent liquid space wasn＇ t formed under the scleral flap.Conclusions NPTS with MMC and AM implant effectively reduced IOP in patients with POAG in long term follow-up.UBM is a new noninvasive method suited for postoperative long-term follow-up of cases with NPTS.AM wasn＇t shown to possess anti-fibrotic properties and facilitate aqueous outflow through the subconjunctival space.Functional filtering blebs were n＇ t essential in NPTS.