个性化的青光眼小梁切除滤过手术疗效观察

Curative effects of individualized trabeculectomy of glaucoma

目的对比个性化青光眼小梁切除术与常规小梁切除术近期、远期效果的差异。方法 2010～2011年在我院治疗的原发性慢性闭角型青光眼患者56例(56眼),随机分为改良组和对照组,每组28例。改良组根据不同个体情况,选用Tenon囊切除,调整巩膜瓣厚薄和虹膜切除面积,滤过口予以少量粘弹剂,巩膜瓣缝合调整松紧;对照组采用常规青光眼小梁切除术。术后随访6个月。结果改良组术后近期、远期的治愈率、有效率优于对照组(P<0.05),虽然早期角膜水肿、滤过泡渗漏稍多,但对症处理后2 w内消失。近期眼压两组无统计学差异(P>0.05),远期眼压改良组优于对照组(P<0.01)。改良组功能性滤过泡远期优于对照组(P<0.05)。结论在青光眼小梁切除术被重新认识的时候,采取个性化的青光眼滤过手术,较常规小梁切除术有较好的临床效果。

Objective To make comparison of short and long term effects between individualized and conventionl trabeculectomy of glaucoma. Methods Fifty six patients （56 eyes） diagnosed as primary chronic angle - closure glaucoma in our hospital from 2010 to 2011 were randomly divided into two groups：improved group and control group with 28 ones in each group. In the improved group, according to different individual situations, Tenon resection was used to adjust the thickness of scleral flap and areas of iridosteresis. Viscoelastic agent was used at the filtration opening, and the modulation of scleral flap suture was made. The control group adopted conventional trabeculectomy. Follow up was made in the 6 months after the operation： Results The short and long term healing rate and effective rate of the improved group were better than those of the control group （ P 〈 0.05 ）. Although in the early stage, many symptoms such as corneal edema and leakage of filtration bleb occurred in the improved group, they all disappeared within 2 w after expectant treatment. There was no significant difference in the short - term intraocular tension between the two groups （P 〉 0.05 ）. But the long - term intraocular tension of the improved group was better than that of the control group（P 〈0.01 ）. The functional filtration 31eb of the improved group in the long term were superior to that of the control group （ P 〈 0.05 ）. Conclusion Individualized trabeculectomy of glaucoma has better clinical effects than conventional trabeculectomy.