粘弹剂对小梁切除术后滤过泡瘢痕包裹的预防作用

The function of viscoelastic substance against the package of filtering blebs after trabeculectomy

目的利用粘弹剂在小梁切除术毕充填于巩膜瓣下及结膜下,在其生物降解和吸收前减少巩膜瓣间及结膜巩膜间粘连形成,以期到达减少小梁切除术后滤过泡瘢痕包裹并满意控制眼内压的目的,观察其疗效和安全性。方法对78例92眼拟行小梁切除术的青光眼患者随机分为治疗组和对照组各46眼,对照组行常规小梁切除术,治疗组在术毕将粘弹剂充填于巩膜瓣下及结膜下,手术后常规处理。观察治疗后滤过泡状态、眼压、炎性反应等其他并发症。结果治疗组和对照组患者治疗后早期眼压控制满意,术后浅前房、角膜水肿、房水渗漏、感染等并发症,两组差异无统计学意义。手术后1年对照组出现11眼不同程度滤过泡瘢痕包裹及眼内压升高,治疗组出现5眼不同程度滤过泡瘢痕包裹及眼内压升高,两组差异有统计学意义。结论粘弹剂在小梁切除术毕充填于巩膜瓣下及结膜下,能减少巩膜瓣间及结膜巩膜间粘连形成,对抑制滤过泡机化包裹,维持满意的眼内压具有一定的作用。

Objective After trabeculectomy, filling sclera under the disc and under the conjunetiva with viscoelastic sub- stance to reduce adhesion sclera between disc and conjunctival between sclera before their biological degradation and absorption, hoping that reducing package of filtering blebs and controlling intraocular pressure well after trabecnlectomy, its efi%acy and safety will be observed. Methods 92 eyes of 78 patients who are ready for trabeculectomy are randomly divided into control group and treatment group with 46 eyes in each group. In control group, patients are only operated conventional trabeculectomy, but in treat- ment group, after conventional trabeculectomy, filling sclera under the disc and under the conjunctiva with viscoelastic substance and observing that the condition of filtering bleb, intraocular pressure, inflammatory responses and other complications after treat- ment. Results No matter in control group or treatment group, the intraocnlar pressure of patients are controlled well. Between the two groups, it doesn＇t appear significant differences on corneal edema, shallow anterior chamber aqueous leakage, infections and other complications. But 1 year after operation, in control group, 11 eyes occurs package of filtering bleb and increased in- traocular pressure with different degree, while in treatment group 5 eyes occurs package of filtering bleb and increased intraocular pressure with different degree and it has significant differences between these two groups. Conclusion After trabeculectomy, u- sing viscoelastic substance to fill sclera under the disc and under the conjunctiva can reduce the adhesion sclera between disc and conjunctival between sclera, suppress the package of filtering bleb and control intraocular pressure well.