非穿透性小梁手术联合交联透明质酸钠生物胶或羊膜植入术治疗开角型青光眼的疗效比较

The clinical observation of nonperforating trabecular surgery with reticulated hyaluronic acid or amniotic membrane implants for the treatment of open angle glaucoma

目的探讨非穿透性小梁手术(nonperforating tra-becular surgery,NPTS)联合交联透明质酸钠生物胶(SK胶)或羊膜植入术治疗开角型青光眼的临床疗效及安全性,并对两种不同植入物的临床疗效进行比较。方法58例(84眼)开角型青光眼患者分为两组,一组行NPTS联合SK胶植入术(36例,53眼),另一组行NPTS联合羊膜植入术(22例,31眼)。术后观察两组患者的视力、眼压、滤过泡、并发症,并进行统计学分析比较。结果术后随访时间6～29个月,平均为(16.2±6.1)个月。SK胶植入组和羊膜植入组术前、术后末次复查时视力差异无显著性(P>0.05),同时两组间术前、术后视力差异无显著性(P>0.05)。术前、术后6～18个月,两组间眼压差异无显著性(P>0.05),但术后第24个月时SK胶植入组平均眼压显著低于羊膜植入组(P<0.05)。SK胶植入组和羊膜植入组手术质量成功率分别为92.5%和90.3%(P>0.05),手术完全成功率分别为75.5%和51.6%(P<0.05)。SK胶植入术组和羊膜植入术组术后前房丁达尔征的发生率分别为28.3%和29%,前房积血发生率分别为15.1%和16.1%,低眼压性黄斑病变发生率分别为15.1%和12.9%,差异无显著性(P>0.05)。结论NPTS联合SK胶或羊膜两种不同植入物均可有效地降低开角型青光眼的眼压,术后并发症少,并且可有效地保护患者的视功能,是治疗开角型青光眼的有效手术方法。NPTS联合SK胶植入术的手术成功率高于羊膜。

Objective To evaluate the clinical effect of nonperforating trabecular surgery （NPTS） with reticulated hyaluronic acid （SK gel） or amniotic membrane implants in the treatment of open angle glaucoma, and to compare the clinical effects of using SK gel and amniotic membrane implants. Methods Fifty-eight patients （84 eyes） with open angle glaucoma were divided into 2 groups： NPTS with SK gel implants （36 cases,53 eyes） and NPTS with amniotic membrane implants （22 cases,31 eyes）. Visual acuity, intraocular pressure, the type of blebs and complications in the two groups were recorded and statistically analyzed. Results All patients were followed up for 6-29 months （16.2±6.1）months. There was no statistically significant difference in visual acuity between the 2 groups. No statistically significant differences in the mean IOP between two groups were found before the operation or 6, 9, 12, and 18 months after the operation （P〉0.05）. However, a statistically significant difference in the IOP of the two groups was found in the postoperative 24th month （P〈0.05）. The success rates for the quality of the treatment options in the SK gel implant group and amniotic membrane implant group were 92.5%, 90.3%, respectively （P〉0.05）. The complete success rates of the treatment options in the SK gel implant group and amniotic membrane implant group were 75.5% and 51.6%, respectively （P〈0.05）. Evidence of Tyndall, hyphema and hypotension-indueed maculopathy were found in 28.3% of the eyes, 15.1% of the eyes, and 15.1% of the eyes, respectively, in the SK gel implant group and in 29.0% of the eyes, 16.1% of the eyes, and 12.9% of the eyes, respectively, in the amniotic membrane implant group （P〉0.05）. Conclusion Nonperforating trabecular surgery with reticulated hyaluronic acid or amniotic membrane implants can effectively lower the IOP of open angle glaucoma and protect visual function. There are much fewer postoperative complications because there was no intraoperative penetration of the anterior chamber. Thus NPTS combined with reticulated hyaluronic acid or amniotic membrane implants is a good treatment method for open angle glaucoma. The success rate of the treatment of NPTS with SK gel was higher than for NPTS with amniotic membrane implants.