三联术与复合性小梁切除术治疗原发性闭角型青光眼的疗效比较

Outcome comparisons of triple surgery and combined trabeculectomy for primary angle-closure glaucoma

目的比较三联术(超声乳化人工晶状体植入联合小梁切除术)与复合小梁切除术(可拆除缝线小梁切除术联合联合丝裂酶素C)治疗原发性闭角型青光眼(PACG)的临床效果。方法应用三联手术对27例(27只眼)青光只眼进行手术治疗,其结果与同类患者30例(34只眼)的复合小梁切除术治疗结果进行比较。术前、术后1个月内每周一次,半年内每月1次,半年后3个月1次做眼压、裂隙灯检查直至1年。比较两者在术后眼压控制及视力恢复情况,并作统计学分析。结果 PACG应用三联术治疗后平均眼压为14.7～2.6 mm Hg,而同类患者经复合小梁切除术治疗后平均眼内压为15.1～3.1 mm Hg。分别经三联术和复合小梁切除术治疗,两类患者眼压在术后早期无明显差异。经三联术治疗,21只眼(77.8%)最佳矫正视力提高,0.3者占33.3%,复合小梁切除术治疗术后6只眼视力不增反降,最佳矫正视力≥0.3者占5.9%,两者差异有显著性。复合小梁切除术治疗术后并发症明显高于三联术治疗组。结论复合小梁切除术治疗早期在控制眼压方面与三联术治疗相当,但三联术治疗长期良好眼压控制成功率较高,在视力恢复和术后并发症控制上效果更加显著。

Objedive To compare the outcomes of the triple surety （ trabeeulectmny combined with phaeoemul- sification and intraocular lens implantation） and the combined trabeculectomy surgery （ trabeculectomy combined with releasable suture and mitomycin C, MMC） in the treatment of primary angle-closure glaucoma （PACG）.Melhods Twenty- seven PACG patiemts （27 eyes） underwent triple surgery, and 30 patients （34 eyes） were treated with combined trabeculectomy surgery. Intraoctdar pressure （lOP） measurements and slit-lamp examinations were performed once he,fore surgery and repeated weekly through the 1 st month after surgery, monthly through the 6th month after surgery, and every 3 months through the 12th month after surgery. The results were compared and analyzed. Results The average early postoperative IOP was 14.7 ± 2.6 mm Hg in the triple surgery group and 15.1± 3.1 mm Hg in the combined tmbeculectomy group. No significant difference was found between the two groups. Best-corrected visual acuity （BCVA） increased in 21 eyes （ 77. 8% ） that received triple surgery, and 33.3% of the eyes achieved an improvement of BCVA ≥0.3. In contrast, BC- VA decreased in 6 eyes that receiv~ combined trabeculectomy, and only 5.9% d the eyes achieved an improvement d BCVA≥0. 3. The difference in BCVA outcomes between two groups was significant. Surgical complications occurred more frequently in the combined trabeculectomy group than in the triple surgery group. Conclusion Combined trabeculectomy had a similar effect on controlling lOP at early postoperative stage, but the rate of successful control of lOP in the long term was better in triple surgery. The triple surgery had better outcomes in the visual acuity and less complications.