非穿透性小梁切除术疗效分析及前节OCT随访观察

The clinical effect of non-penetrating trabecular surgery and AS-OCT follow up

目的研究非穿透性小梁手术non—penetrating trabecular surgery，NPTS）联合透明质酸钠凝胶或羊膜植入术治疗开角型青光眼的临床效果，并探讨前节OCT在NPTS术后随访中的作用。方法临床病例自身对照研究。对2006年5月至2009年11月在温州医学院附属眼视光医院就诊的42例（48只眼）开角型青光眼患者进行NPTS联合透明质酸植入物或生物羊膜治疗，其中11只眼联合羊膜植入，37只眼联合透明质酸植入。术后观察视力、眼压、并发症及滤过泡形态。随访时间6～48月，平均（18．56±11．49）月。末次随访时进行前节OCT观察残留的小梁网－狄氏膜、巩膜池和滤过泡等情况。结果术前最高眼压平均（38．38±10．60）mmHg，术后第1天眼压，平均（8．59±3．51）mmHg，末次随访眼压（19．91±9．28）mmHg，术后不同时间段眼压较术前相比均下降，差异有统计学意义（P〈0．05）。末次随访时视力与术前不变者36只眼（75．0％），视力下降者5只眼（10．4％），视力提高者7只眼（14．6％）。末次随访时完全成功26只眼（54．2％），条件成功17只眼（35．4％），失败5只眼（10．4％）。术后6只眼出现前房变浅，3只眼前房少许出血，均无明显前房炎性反应、持续性低眼压及脉络膜上腔出血等并发症发生。前节OCT可以清晰地观察到残留的小梁网－狄氏膜、巩膜池、巩膜瓣上液间腔、滤过泡壁厚度等。结论NPTS联合透明质酸或生物羊膜植入物能较有效降低眼压，手术并发症少。前节OCT可以作为NPTS术后随访的一种安全无创的检查工具。

Objective To evaluate the effectiveness of non-penetrating trabecular surgery （NPTS） combined with reticulated sodium hyaluronate or amnion implant for open angle glaucoma and the value of anterior segment optical coherence tomography . （AS-OCT） in the follow-up of NPTS. Methods NPTS was performed on 48 eyes of 42 patients, among whom 37 eyes with reticulated sodium hyaluronate implant, 11 eyes with amnion implant. Main outcome measures included visual acuity, intraocular pressure （IOP）, filtering blebs and complications. The follow-up period was 6 to 48 months （mean 18.56± 11.49 months）. Anterior chamber OCT was undertaken to evaluate the rudimental trabecular membrane, bleb and scleral cavity of the surgical site on the last follow-up time. Results The IOP was decreased from a mean preoperative value of （38.38± 10.60） mmHg to a mean postoperative value of （8.59± 3.51） mmHg and （19.91± 9.28） mmHg on the first day and on the last visit respectively. Postoperative IOP at every visit point was lower than the preoperative value （P 〈0.01）, 36 eyes （75.0%） remained stable visual acuity on the last visit compared with preoperative visual acuity, 5 eyes （10.4%） decreased and 7 eyes （14.6%） elevated. The complications such as inflam- mation, suprachoroidal hemorrhage and persistent hypotention were not observed except 6 fiat chambers and 3 moderate anterior chamber hemorrhage. The completely successful rate on last visit was 26 eyes （54.2%）, conditional successful rate was 17 eyes （35.4%） and failure 5 eyes （10.4%）. The anterior segment OCT could be observed the rudimental trabecular reticulum-descement membrane, scleral cavity, suprascleral cavity and bleb thickness, et al. Conclusions Non-penetrating trabecular surgery with reticulated sodium hyaluronate or amnion implant can effectively lower the IOP without severe complications. Anterior segment OCT is a safe and atraumatic tool for NPTS follow up.