非穿透性小梁手术与小梁切除术治疗青光眼的远期疗效对照研究

Long-term effects of non-penetrating trabecular surgery versus trabeculectomy for treating glaucoma

目的 探讨非穿透性小梁手术治疗青光眼的远期疗效.方法 病例对照研究.非穿透性小梁手术后患者31例（31只眼）为A组,同期小梁切除术患者32例（32只眼）为B组.对两组患者的眼压、滤过泡、视野及并发症等情况进行病例对照研究.采用SAS 8.0统计学软件进行数据分析.两组患者术后眼压值比较,采用具有一个重复测量两因素设计定量资料的方差分析;术后结膜滤过泡消失率和视野改变等情况比较,采用CMH X2检验.以P〈0.05作为差异有统计学意义.结果 （1）眼压：手术后1个月至5年,A组患者眼压为（13.87±4.88）mm Hg（1 mm Hg=0.133 kPa）至（24.01±6.55）mm Hg,眼压随时间推移有较明显的升高趋势;B组患者眼压（11.90±4.92）mm Hg至（19.10±7.43）mm Hg;两组患者眼压比较,差异有统计学意义（F=5.137,P〈0.05）.（2）滤过泡：术后B组患者均形成明显的功能性滤过泡;A组仅有25只眼（80.6%）形成明显的功能性滤过泡,6只眼仅见滤过泡轻度隆起;随着时间推移,两组患者滤过泡消失的差异有统计学意义（X2=8.129,P〈0.05）.（3）视野：术后随访5年,A组有11只眼（39.29%）视野缩小,B组有6只眼（23.08%）视野缩小,但两组视野缩小差异无统计学意义（X2=1.347,P〉0.05）.（4）并发症：术后随访5年,B组并发白内障12只眼（12/26,46.15%）,A组并发白内障6只眼（6/28,21.43%）,两组间差异有统计学意义（X2=3.797,P〈0.05）.（5）手术成功率：B组为61.54%（16/26）,A组为14.29%（4/28）,两组间差异有统计学意义（X2=14.463,P〈0.05）.结论 非穿透性小梁手术与小梁切除术均是治疗原发性开角型青光眼的有效方法.与小梁切除术相比,非穿透性小梁手术安全性较好,术后合并症较少,但远期疗效尚不确定,需谨慎选用.

Objective To evaluate clinical outcomes of non-penetrating trabecular surgery （NPTS）and trabeculectomy surgery （TS） in the treatment of primary open angle glaucoma （POAG）. Methods It was a case-control study.A total of 63 patients （63 eyes） with POAG were observed retrospectively.Thirty one eyes and 32 eyes underwent NPTS and TS,respectively.Intraocular pressure（IOP）,filtration bleb,visual field and post-operative complications were observed for 6-60 months.The CMH X2 test was used to analyse the difference of them.Results After operation.the IOP in the NPTS group were from（13.87±4.88）mm Hg（1 mm Hg=0.133 kPa） to （24.01±6.55）mm Hg,the IOP in the TS group were from（11.90±4.92）mm Hg to（19.10±7.43）mm Hg.The IOP in the NPTS group was significantly higher than that in the TS group （F=5.137,P〈0.05）.The ratio of sustained filtration bleb of NPTS group after surgery was 25/31（80.6%）,while 6/31 were flat filtration bleb.There were statistically significant difference in the rate of disappearance of filtration bleb between these two groups（X2=8.129,P〈0.05）.The difference of visual field loss postoperatively between these two groups was not statistically significant.The incidence rate of newly developed cataract after NPTS and TS was 6/31 and 12/32.respectively.The difierence of rate of complication between these two groups was statistically non-significant（X2=3.797,P〈0.05）.The successful rate after NPTS and TS was 61.54%（16/26）and 14.29%（4/28）,respectively.The difference of successful rate between these two groups was statistically significant（X2=14.463,P〈0.05）.Conclusions Both NPTS and TS are effective methods for the treatment of POAG.Postoperative complications after NPTS are less than those of TS.But patients with TS could maintain a lower IOP than those with NPTS.Long-term efficacy of NPTS is uncertain.it＇s important to choose the suitable surgery to gain a high success rate.