单纯性非穿透性小梁显微手术治疗青光眼的临床效果

A prelimary report of non-penetrating trabecular surgery for patients with primary open-angle glaucoma

目的评价单纯性非穿透性小梁显微手术在治疗原发性开角型青光眼中的近期临床疗效６方法对１６例２０眼原发性开角型青光眼患者进行不加植入物的非穿透性小梁手术治疗，术后观察眼压、限内反应、滤过泡形态，并对手术区域进行超声生物显微镜检查。随访时间平均（４．２±２．４）个月。结果术前平均眼压（３．７８±１．１１） ｋＰａ，术后 ３个月平均眼压（２．０８±０．５１） ｋＰａ，差异有显著性（Ｐ＜０． ０１）。无需额外药物治疗而术后眼压≤２． ８０ ｋＰａ者占 ６５％，需加用局部药物占 ３５％。所有患者术前与术后视力差异经Ｘ２检验无统计学意义；无１例出现前房变浅、炎症、脉络膜脱离等并发症。超声生物显微镜检查显示眼压控制良好者在巩膜瓣下形成一透明液性间腔，在结膜下有功能性滤过泡形成。结论不加植入物的非穿透性小梁显微手术在近期能有效降低眼内压，是一种对开角型青光眼很有应用前景的抗青光眼手术。

Objective To evaluate the clinical effect of non-penetrating trabecular surgery (NPIS) without subscleral implantation in primary open-angle glaucoma (POAG) Methods Twenty eyes of 16 patients with POAG were underwent NPTS The procedure involved excising a deep-scler- sclera tissue that flush with innerwall of Schlemm's canal without opening the anterior chamber. The postoperative intraocular pressure (IOP), inflammation and filtering bleb were analysised. All of patients were undertaken ultrasound biomicroscopy (UBM ) to evaluate the surgery site on postoperative 2 weeks and 3 months. Mean follow-up was (4. Z± 2. 4) months. Results The IOP decreased from preoperative average value of (3.78± 1. 11 ) kPa, to postoperative average value of (2. 08± 0. 51 ) kPa (P<0. 01). The complications such as flat chamber, inflammation and detachment of choroid were not observed' The UBM showed that transparent liquid space was formed under the scleral flap in the patients with normal IOP on postoperatively 3 months. The filtering blebs were formed in these patients. Conclusion Nonpenetrating trabecular surgery without subsclcral implantation could also effectively decrease IOP' It is proved to be a promising technique to treat open-angle glaucoma,