两种小梁切除术治疗闭角型青光眼的临床分析

Comparisons between two suturing techniques in trabeculectomy for angle closure glaucoma

目的观察单纯小梁切除术、小梁切除术联合可调整缝线术治疗青光眼的临床疗效。方法收集闭角型青光眼患者94例(128只眼),将其随机分为两种:其中1组采用小梁切除术联合可调整缝线术治疗共49例(66只眼),2组采用单纯小梁切除术治疗共45例(62只眼),对其疗效进行对比分析,观察治疗前后眼压、前房深度、房角的变化、虑过泡。结果房角镜检查:术前1组66只眼房角关闭粘连≤90°者1只眼,房角关闭粘连90°～180°者23只眼,房角关闭粘连180°～360°者42只眼;2组62只眼房房角关闭粘连≤90°者1只眼,房角关闭粘连90°～180°者20只眼,房角关闭粘连180°～360°者41只眼;术后1组66只眼房角完全开放45只眼,房角关闭粘连≤90°者17只眼,房角关闭粘连90°～180°者3只眼;2组62只眼房角完全开放41只眼,房角关闭粘连≤90°者14只眼,房角关闭粘连90°～180°者7只眼。术前1组眼压为(36.9±5.2)mm Hg,2组眼压为(37.1±5.4)mm Hg;术后1周后眼压控制:1组(12.4±4.35)mm Hg,2组(14.3±5.08)mm Hg。术前前房深度:1组为(1.73±0.42)mm,2组为(1.78±0.39)mm;术后前房深度:1组为(3.25±0.36)mm,2组为(2.91±0.53)mm。术后,1组高眼压率与2组无明显差异;1组早期低眼压、浅前房的发生率明显低于2组;1组功能性虑过泡形成率明显高于2组。结论小梁切除术联合可调整缝线术治疗闭角型青光眼的可明显提高手术的成功率,有效的控制眼压,减少手术早期并发症。

Objective The aim of this study is to observe the clinical outcomes of trabeculectomy vs.trabeculectomy with adjustable suture in treatment of the glaucoma,and to provide a reliable method for the treatment of angle-closure glaucoma.Methods Ninety-four patients with angle closure glaucoma（128 eyes） were randomly assigned into two groups.Patients of group one（49 cases,66 eyes） underwent trabeculectomy with adjustable,whereas patients of group two（45 cases,62 eyes） received routine trabeculectomy.The clinical parameters,including intraocular pressure,anterior chamber depth,changes in chamber angles,and filtering bleb conditions were observed before and after surgeries.Results Preoperative gonioscopy results： the degree of angle closure adhesion was ≤ 90° in 1 eye,between 90° ～180° in 23 eyes,and between 180° ～ 360° in 42 eyes in patients of group one.In patients of group two,the degree of angle closure adhesion was ≤ 90° in 1 eye,between 90° ～180° in 20 eyes,and between 180° ～360° in 41 eyes.Postoperatively,45 eyes became complete open chamber angle,17 eyes had angle closure adhesion ≤90°,and 3 eyes had angle closure adhesion between 90°-180° in patients of group one.In patients of groups two,41 eyes became complete open chamber angle,14 eyes had angle closure adhesion ≤90°,and 7 eyes had angle closure adhesion between 90°-180°.Average preoperative intraocular pressure was（36.9 ± 5.2） mm Hg in group one and was（37.1 ± 5.4） mm Hg in group two.One week after the surgery,IOP average was（12.4 ± 4.35） mm Hg in group one and was（14.3 ± 5.08） mm Hg in group two.Preoperative anterior chamber depth was（1.73 ± 0.42） mm in group one and was（1.78 ± 0.39） mm in group two.Postoperatively,chamber depth became（3.25 ± 0.36） mm in group one and became（2.91 ± 0.53） mm in group two.After operation,the incidence of shallow anterior chamber was significantly lower in group one than in group two.The rate of functional filtration bleb formation was significantly higher in group one than in group two.Conclusion Trabeculectomy with adjustable suture can significantly improve the successful rate of the operation and can effectively control the intraocular pressure and avoid the operation complications.