全周Schlemm管线性切开术治疗原发性开角型青光眼

Schlemm cannal cut open circumferentially with a string to treat open angle glaucoma

目的探索全周Schlemm管线性切开治疗原发性开角型青光眼临床疗效及安全性。方法对20例（25只眼）原发性开角型青光眼患者成功行全周Schlemm管线性切开术,术后观察视力、前房反应、眼压、滤过泡、并做前房角镜检查。结果术后随访4.6～13个月,平均（7.5±3.1）个月。术前平均眼压（28.5±9.6）mmHg（1mmHg=0.133Kpa）,术后（15.4±4.2）mmHg;差异有非常显著性（t=5.765,P〈0.001）。术前平均用药（2.5±0.69）种,术后（0.68±0.59）种,差异有非常显著性（t=8.101,P〈0.001）,随访期间眼压≤21mmHg者24只眼（96.0%）,其中13只眼（52.0%）不用抗青光眼药物,11只眼（44.0%）加用抗青光眼药物。眼压下降≥10mmHg者14只眼（56.0%）,其中不加药者7只眼。术后17只眼无任何眼内反应;6只眼有轻微房水闪光,2～4d消失;2只眼有少量前房积血,3～7d消失。3只眼术后出现局限性滤过泡,2～4周消失。房角镜下观察25只眼小梁网处均见裂隙带。结论全周Schlemm管线性切开术可有效降低眼压,并减少抗青光眼药物的应用,术后并发症少,为一种具有良好应用前景的抗青光眼新手术。

Objective To evaluate the clinical effect and safety of Schlemm cannal cut open circumferentially with a string to treat open angle glaucoma. Methods 20 patients （25 eyes ） diagnosed open angle glaucoma underwent Schlemm cannal cut open circumferentially successfully, and the visual acuity, anterior chamber reaction, intraocular pressure （IOP）, infiltration bulb, and the anterior chamber angle of them were observed. Results All the patients were followed 4.6 to 13 month （mean 7.5 ＋ 3.1 months）. The mean preoperative and postoperative IOP was 28.5（9.6 mmHg and（15.4 ＋ 4.2）mmHg, respectively（lmmHg=0. 133Kpa）.There was significant difference between them （t=8.101 ,P〈0.001 ）. Numbers of anti-glaucoma drugs received preoperatively decreased significantly than postoperatively （2.5 ± 0.69 vs 0.68 ±0.59, P〈0.001）. During the follow-up, the IOP in 24 eyes （96%） can be controled below 21 mmHg, and within them 11 eyes （44. 0%） required anti-glaucoma drugs, 13 eyes （52.0%） did not. The IOP in 14 eyes （56.0%） decreased more than 10 mmHg than preoperative, and within them no anti-glaucoma drugs in 7 eyes. There was no inflammatory reac- tion in 17 eyes, and minor aqueous flare in 6 eyes, which disappeared in 2-4 days. Small quantity hypbema in 2 eyes, and were absorbed in 3-7days. Local infiltration bulb took place in 3 eyes after operation, and disappeared in 2-4 weeks. All the patients can be observed fissures in the trabecular meshwork under goioscopy. Conclusion As a new type of anti-glaucoma operation, Schlemm cannal cut open circumferentially with a string will have a good perspective because it can decrease IOP and the use of anti-glaucoma drugs effectively, and has few postoperative complications.