小梁滤过术联合巩膜层间硅胶片植入治疗难治性青光眼

Trabeculetomy combined with implantation of silicon rubber slice for refractory glaucoma

目的：评价小梁滤过术联合巩膜层间填充硅胶片治疗难治性青光眼的效果及并发症。方法：采用小梁滤过术联合巩膜层间填充硅胶片治疗难治性青光眼共32例32眼（试验组）,即小梁切除术联合硅胶片填充于巩膜层间;采用单纯小梁滤过术治疗难治性青光眼21例21眼（对照组）。术后观察两组眼压降低效果及并发症。结果：术后追踪随访6～24mo。试验组术后平均眼压14.36±5.2mmHg（1mmHg=0.133kPa）,眼压超过30mmHg者3眼（9.4%）。术后随访时间内未发现与硅胶片填充有关的严重并发症及硅胶片排斥反应。对照组术后平均眼压23.36±9.3mmHg,眼压超过30mmHg者5眼（23.8%）。结论：巩膜层间填充硅胶片是治疗难治性青光眼的有效方法。由于其经济、简便,尤其是在我国广大基层医院可以代替昂贵进口引流性植入物治疗难治性青光眼,可为多数患者接受,值得推广应用。

AIM： To evaluate the effect of trabecular filtration surgery combined with scleral interlayer filled with silicon rubber for refractory glaucoma and its complications. METHODS： A total of 32 cases （32 eyes） of refractory glaucoma underwent trabecular filtration surgery combined with sclera interlayer filled silicone piece, namely trabeculectomy combined silicon rubber filled in sclera between layers was as experimental group. Twenty-one cases （21 eyes） treated by simple trabecular filtration surgery were as control group. Reducing effect of intraocular pressure （lOP） and complications of two groups were observed after operation. RESULTS： Postoperative follow-up was 6-24 months. The mean lOP was 14.36±5.2mmHg （ 1 mmHg = 0. 133kPa） in experimental group and 23. 36± 9. 3mmHg in control group after operation, lOP of three eyes （9. 4%） in experimental group and 5 eyes （23.8%） in control group was over 30mmHg. There was no serious complications and rejection correlated with silicone piece during the follow-up period. CONCLUSION：Silicone piece filled between sclera layer is an effective method for refractory glaucoma, and can effectively reduce lOP. Due to its economic, convenient, especially can replace expensive imported drainage plant figure treatment of refractory glaucoma in our country the grass-roots hospital, it should be widely applied.