微创小梁切除联合生物羊膜移植术治疗青光眼观察

Clinical observation of micro-invasive trabeculectomy combined with biological amniotic membrane implantation

目的通过减少手术创面，探讨微创小梁切除联合生物羊膜移植术治疗青光眼的临床价值。方法在小梁切除联合羊膜移植术中，64只青光眼被随机分人2组，微创组32只眼，制作4mm-4mm结膜瓣和2．5mm-2．5mm巩膜瓣，切除1mm-1．5mm小梁组织？常规组32只眼，使用常规手术方法即8minx8mm结膜瓣、4mm ×4mm巩膜瓣，切除小梁组织1．5min×3mm。术后观察眼压、色素膜、滤过泡、角膜内皮的变化，平均随访8个月。结果（1）微创组和常规组术后1年的平均眼压分别为（17．36±4．25）和（15．41±6．21）mmHg，两组对比差异无统计学意义（P〉0．05）。（2）两组术后早期均形成明显弥散滤过泡，12个月后有功能滤过泡者微创组占78．12％（25／32），常规组占62．5％（20／32），差异无统计学意义（P〉0．05）。（3）术后早期常规组色素膜反应比微创组重，且浅前房或伴发脉络膜脱离发生率较多：两组差异有统计学意义（P〈0．05）。（4）术后12个月微创组和常规组内皮平均丢失率为9．6％（180．511880）和16．3％（306．4／1880），两组差异有统计学意义（P〈O．01）。结论微创小梁切除术联合羊膜移植治疗青光眼，手术创伤小、术后色素膜反应轻、内皮损失少，疗效良好。

Objective To explore the clinical value of micro-invasive trabeculectomy combined with biological amniotic membrane implantation through reducing the surgically traumatic area. Methods In the surgeries of trabeculectomy combined with biological amniotic membrane implanta- tion, 64 eyes with glaucoma were divided randomly into 2 treatment groups. In the group of mi- cro-invasive trabeculectomy was given to 32 eyes by making conjunctival flap measuring 4x4mm, scleral flap measuring 2.5 ×2.5mm, and resecting the trabecular meshwork measuring 1 × 1.5mm. In the group of conventional trabeculectomy was given to 32 eyes by making conjunctival flap measur- ing 8×8mm, scleral flap measuring 4×4mm, and resecting the trabeeular meshwork measuring 1.5× 3mm. After the surgery, the changes of the intraocular pressure （lOP）, the uvea, the filtering bleb and the corneal endothelium were observed and recorded. And the average follow-up duration was 12 months. Results At 12 months post-surgery, the IOP in the micro-invasive group and the con- ventional group were （17.36±4.25） and （15.41±6.21）mmHg, respectively. There was no significant dif- ference between these 2 groups （P 〉0.05）. There were obvious diffusing filtering blebs at the early stage post-surgery in these 2 groups. After 12 months, 78.12% （25/32） eyes of the micro-invasive group still had functional filtering blebs, while 62.5% （20/32） eyes of the conventional group. There was no significant difference between these 2 groups （P 〉0.05）. The micro-invasive group had milder uveal reaction at the early stage post-surgery than the conventional group. And the incidence of shallow anterior chamber or concomitant with choroidal detachment was higher in the conventional group, there was obvious difference between these 2 groups （P 〈0.05）. At 12 months post-surgery, the loss rate of the corneal endothelium of the conventional group was 16.3% （306.4/1880）, while 9.6% （180.5/1880） on the micro-invasive group. And there was obvious difference between these 2 groups （u =2.813, P 〈0.01）. Conclusions The micro-invasive trabeculectomy combined with biologi- cal amniotic membrane implantation has good clinical effect with less operational trauma, less uveal reaction and less loss of the corneal endothelium.