超常规小梁-巩膜带切除术与常规小梁切除术治疗青光眼的疗效比较

Comparison of a modified trabecular-sclerectomy and a normal trabeculectomy to treat glaucoma

目的探讨超常规小梁—巩膜带切除术治疗青光眼的疗效和临床应用价值,并与常规小梁切除术的疗效进行比较。方法选择110例(110眼)准备行小梁切除术的青光眼患者,分为A、B两组,A组(58例)行超常规小梁—巩膜带切除+虹膜周切术,B组(52例)行常规小梁切除+虹膜周切术。比较两组术后早期眼压控制和前房形成情况、术后远期滤过泡形成和眼压控制情况。采用χ2检验和t检验对所得数据进行统计学分析。结果术后早期(1周)眼压控制(<21mmHg)数和浅前房:A组分别为54眼(93.1%)和25眼(43.1%),B组分别为44眼(84.6%)和18眼(34.6%),经卡方检验,两组差异无统计学意义(P>0.05)。术后早期,A组眼压为(11.20±2.13)mmHg,B组为(12.12±2.07)mmHg,经t检验差异无统计学意义(P>0.05)。术后远期(6～26个月)良好功能滤过泡和眼压控制数:A组分别为41眼(70.7%)和48眼(82.8%),B组分别是27眼(51.9%)和31眼(59.6%),经卡方检验,差异均有统计学意义(P<0.05)。术后远期,A组眼压为(12.21±1.98)mmHg,B组(13.79±3.27)mmHg,经t检验差异有统计学意义(P<0.05)。结论超常规小梁—巩膜带切除+虹膜周切术较常规小梁切除+虹膜周切术远期眼压控制效果好,同时避免了使用抗细胞代谢药物或其他操作所带来的并发症,结果令人满意。

Objective To evaluate the outcome of modified trabecular-sclerectomy and its clinical application.Methods Group A included 58 randomized glaucoma patients who agreed to undergo a modified trabecular-sclerectomy while group B included 52 patients who underwent a normal trabeculectomy.The anterior chamber formation,filtration bulb function and control of intraocular pressure （IOP） in the early stage and over the long term were compared.Results In group A,IOP was controlled in 54 cases （93.1%） during the early stage,and a shallow anterior chamber occurred in 25 cases （43.1%）.While in group B,IOP was controlled in 44 cases （84.6%） and 18 cases （34.6%） had a shallow anterior chamber formation.There was no statistically significant difference between the two groups.The difference in IOP between the two groups during the early stage [group A,（11.20 ±2.13）mmHg;group B,（12.12 ± 2.07）mmHg] was not statistically significant.Observation over long term found that 41 cases （70.7%） from group A estab...更多lished a functional filtration bulb and IOP was controlled in 48 cases （82.8%）.However,only 27 eyes （51.9%） in group B obtained a functional bulb and IOP in 31 eyes （59.6%） had appropriately decreased.Statistical analysis found a significant difference between the two groups.There was also a significant difference between the two groups in the control of IOP over the long term [group A,（12.21±1.98）mmHg;group B,（13.79±3.27）mmHg].Conclusion The results show that a modified trabecular-sclerectomy,in which anti metabolism drugs and its side effects could be avoided,resulted in better long-term IOP control than traditional surgery.