比较巩膜瓣不同缝合法对小梁切除术术后效果的影响

Comparison of postoperative effects of different suture of scleral flap in trabecul- ectomy

目的:评价原发性急性闭角型青光眼小梁切除术中巩膜瓣不同缝合法的临床疗效。方法:将60例68眼本院确诊为原发性急性闭角型青光眼的患者随机分为两组。A组30例33眼,术中巩膜瓣采用四针缝合法,B组30例35眼,术中巩膜瓣采用两针缝合法。术后观察眼压、前房深度、滤过泡形态等,随访6mo。结果:(1)术后第2d两组眼压对比,差异有统计学意义(t=5.8765,P<0.05);术后2wk眼压对比,差异无统计学意义(t=1.2347,P>0.05);术后1mo眼压对比,差异无统计学意义(t=1.4350,P>0.05);术后3mo眼压对比,差异无统计学意义(t=1.3548,P>0.05);术后6mo眼压对比,差异无统计学意义(t=1.5753,P>0.05)。(2)术后第2d,A组浅前房发生率为6%,B组为17%,A组浅前房主要以浅Ⅰ度为主,两组对比差异有统计学意义(χ2=6.4513,P<0.05);术后第1wk,A组浅前房发生率为0,B组为3%,两组对比差异无统计学意义(χ2=0.7341,P>0.05)。(3)两组患者术后1,6mo功能性滤过泡形成率:术后1moA组为97%,B组为94%,两组对比差异无统计学意义(χ2=0.7301,P>0.05);术后6moA组为88%,B组为86%,两组对比差异无统计学意义(χ2=0.8172,P>0.05)。结论:在原发性急性闭角型青光眼患者行小梁切除术时,四针缝合的巩膜瓣在短期内可以较好的控制眼压,减少早期浅前房的发生率。

AIM： To evaluate clinical efficacies of different suture of scleral flap in trabeculectomy for the primary acute angle- closure glaucoma, METHODS： Totally 60 cases （68 eyes） of confirmed primary acute angle- closure glaucoma were randomly divided into two groups. Group A （four-needle suture of scleral flap） were 30 cases （33 eyes）. Group B （two- needle suture of scleral flap） were 30 cases （35 eyes）. Postoperative intraocular pressure, anterior chamber depth and filtering bleb shape were compared. All cases were followed-up for 6 months. RESULTS： （1） On the 2nd postoperative day, compared intraocular pressure （lOP） of both groups, the difference was statistically significant （t = 5. 8765, P 〈0 05） ; 2 weeks of post-operation, compared 10P of both groups, there was no statistically significant difference （ t= 1.2347, P〉0.05） ; In the 1st month after operation, compared 10P of both groups, the difference was not statistically significant （ t= 1.4350, P〉0.05） ; In the 3rd month postoperatively, compared lOP of both groups, the difference was not statistically significant （ t = 1. 3548, P〉 0.05） ; 6 months after operation, compared 10P of both groups, there was no statistically significant difference （ t= 1. 5753, P〉0.05）. （2） On the 2nd postoperative day, the incidence rate of shallow anterior chamber in group A was 6%, and that of group B was 17%. Shallow anterior chamber in group A was mainly shallow I. Compared the incidence rate of shallow anterior chamber between both groups, the difference was statistically significant （X2 = 6. 4513, P〈0.05）; 1 weekafter operation, the incidence chamber in group A was 0 rate of shallow anterior and 3% in group B respectively. Compared the incidence rate of shallow anterior chamber between both groups, the difference was not statistically significant （X2=0.7341, P〉0.05）. （3） functional filtration bubble formation rate of patients of two groups in 1 month and 6 months postoperatively： that of 1 month after operation in group A was 97% and 94% in group B respectively, compared them between two groups, the difference was not statistically significant （X2 = 0. 7301, P〉0.05） ; That of 6 months after operation in group A was 88% and 86% in group B respectively, the difference was not statistically significant when compared them between two groups （X2=0.8172,P〉0.05）. CONCLUSION. In primary acute closed-angle glaucoma underwent trabeculectomy, four stitches of the scleral flap can better control lOP in the short term, and reduce the incidence rate of early shallow anterior chamber.