巩膜蓄水池样复合式小梁切除术治疗难治性青光眼

Compound trabeculectomy with sluice-like pool under sderal flap for treatment of refractory glaucoma

目的探讨巩膜瓣下蓄水池样小梁切除术联合羊膜移植及术中应用丝裂霉素c治疗难治性青光眼的临床效果。方法将不同类型的难治性青光眼95例（102眼）随机分为2组，观察组48例（52眼）行巩膜蓄水池式小梁切除术联合羊膜植入及术中应用丝裂霉素C和可调整缝线，对照组47例（50眼）行常规的小梁切除术。术后随访4～15个月。结果术后视力两组间比较差异无统计学意义（X2=1．14，P=0．75）。术后2周两组眼压均较其术前为低差异有统计学意义，而组间比较差异无统计学意义（t=1．86，P=0．08）；术后6个月观察组平均眼压（14．75±3．87）mmHg，对照组（19．25±7．14）mmHg；手术成功率：观察组86．54％，对照组64．00％，观察组成功率较高，两组间差异有统计学意义（X2=3．85，P〈0．05）。功能性滤过泡观察组83．0％，对照组61．4％，两组比较差异有统计学意义（X2=5．53，P=0．02）。术后观察组出现浅前房较对照组多，治疗后1周均恢复正常。结论与常规小梁切除术相比，巩膜蓄水池样小梁切除术联合羊膜植入及术中应用丝裂霉素C和可调整缝线治疗难治性青光眼，在防止滤过道瘢痕形成，术后控制眼压等方面有一定优势。

Objective To investigate the clinical efffect of compound trabeculectomy with sluice-like pool under scleral flap combined with amniotie membrane transplantation, mitomycin-C and adjustable sutures in treating refractory glaucoma. Methods 102 eyes of 95 patients were randomly assigned to receive trabeculectomy with or without sluice pool. The observer group（52 eyes of 48 patients） underwent trabecu- lectomy with sluice-like pool under scleral flap combined with amniotic membrane transplantation and mito- mycin-C application. The control group （50 eyes of 47 patients） underwent conventional trabeeulectomy. The follow-up were from 4 months to 15 months. Results No significant differences in visual acuity were found between the two groups 0（2 = 1.14, P = 0.75 ）. The postoperative IOPs were significantly lower than the preoperative IOPs in both groups, while the IOPs between the two groups were not significantly different two weeks after the surgery （ t = 1.86, P = 0.08 ）. The average postoperative IOP at the 6 months was （14.75 ± 3.87 ） mmHg in the observer group and （19.25 ± 7.14）mmHg in the control group; The success rates were 86.54% and 64.00% in the two groups respectively （X2 = 3. 85, P 〈 O. 05 ）. The percentage of functional fihering blebs in the observer group was 83.0%, significantly higher than that of the control group （61.4%） （X2 =3. 85, P 〈0.05）. The incidence rate of shallow anterior chamber in the observer group was higher than that in the control group , but all the cases had recovered by the end of 1 week after operation. Conclusion The Combined trabeeulectomy with shuice-like pool has the advantages of preventing postoperative scar formation and achieving better control of postoperative IOP over the conventional trabeculectomy in treating refractory glaucoma.