单纯复合式小梁切除术与复合式小梁切除联合羊膜植入术对比研究

Comparative study of compound trabeculectomy with and without amniotic membrane

目的评价生物羊膜在复合式小梁切除术中应用的安全性和有效性。方法采取对照研究对2006年4月至2009年3月在温州医学院附属眼视光医院确诊并双眼均需手术治疗的青光眼患者25例(50眼),其中一眼行复合式小梁切除联合生物羊膜植入术(A组),另一眼行单纯复合式小梁切除术(B组)。记录2组患者术前、术后平均眼压、滤过泡类型、手术前后的视力、并发症发生情况。结果 A组患者术前眼压为10.20～50.60mmHg(1kPa=7.5mmHg),平均为(31.77±12.93)mmHg,最终随访时眼压6.70～19.90mmHg,平均为(12.51±3.99)mmHg;B组患者术前眼压为11.70～53.00mmHg,平均为(31.11±12.62)mmHg,最终随访时眼压为7.50～27.80mmHg,平均为(14.52±5.01)mmHg;最终随访时A组平均眼压控制情况比B组低,差异有统计学意义(t=2.26,P<0.05)。A组功能性滤过泡23眼,B组20眼,2组比较差异无统计学意义(P>0.05)。2组术后视力变化比较,差异无统计学意义。2组患者均未发生严重并发症。结论生物羊膜应用于复合式小梁切除术可有效、平稳、充分降低眼压,并可促进功能性滤过泡形成,提高手术成功率,且羊膜的应用未见并发症明显增加。

Objective To evaluate the safety and effectiveness of compound trabeculectomy with amniotic membrane.MethodsComparative study was taken in 25 cases（50 eyes）with glaucoma in Hospital of Optometry Ophthalmology of Wenzhou Medical College from April 2006 to March 2009,and both eyes of each case were need to take operation.One eye was treated with compound trabeculectomy with amniotic membrane（group A）and the contralateral eye only with compound trabeculectomy（group B）.The mean intraocular pressure（IOP）was measured pre-and postoperatively.Bleb type,visual acuity and the incidence of complications were noted.ResultsThe preoperative mean IOP were（31.77±12.93）mmHg（10.20 mmHg to 50.60 mmHg;1 kPa=7.5 mmHg）in group A and（12.51±3.99）mmHg（11.70 mmHg to 53.00 mmHg）I group B.The mean IOP were（12.51±3.99）mmHg（6.70 mmHg to 19.90 mmHg）at the last following up time in group A and（14.52±5.01）mmHg in group B.The mean IOP was lower in group A than in group B at the last following up time（t=2.26,P0.05）.There were 23 eyes with functional filtering blebs in group A and 20 eyes in group B（P0.05）.No difference was found in change of visual acuity between the two groups.No serious complication was found in both two groups.ConclusionsThe use of amniotic membrane in the compound trabeculectomy can effectively,stably and completely reduce IOP compared with the simply trabeculectomy,and helps the formation of functional blebs which improves the surgery efficiency.No obvious increase of complication is found with application with amniotic membrane.