小梁切除与眼球筋膜切除联合羊膜移植治疗开角型青光眼

Combined surgery of ocular tenonectomy, trabeculectomy and amniotic membrane transplantation for the treatment of primary open angle glaucoma

目的 评价小梁切除与眼球筋膜切除联合生物羊膜移植治疗原发性开角型青光眼的临床效果。方法 对48例（65只眼）进展期原发性开角型青光眼进行小梁切除与眼球筋膜切除联合生物羊膜移植术，术后进行6～18个月随访，对视力、眼压、眼底及滤过泡情况进行观察。结果 所有患者术后视力均无明显下降，无严重并发症。术后1周眼压为（11．80±3．50）mmHg（1mmHg=0．133kPa），与术前的（33．50±5．50）mmHg相比，差异有统计学意义（t=65．86，P〈0．05）。术后18月80．65％（25／31）形成功能性滤过泡。65只眼末次随访时手术完全成功率为69．23％（45／65），条件成功率24．62％（16／65），二者合计为93．85％（61／65）。结论 小梁切除与眼球筋膜切除联合羊膜移植能有效降低眼压，是治疗开角型青光眼安全有效的术式之一。

Objective To evaluate the effect of combined surgery of ocular tenonectomy, trabeculectomy and amniotic membrane transplantation for the treatment of primary open angle glaucoma. Methods Sixty-five eyes of 48 cases with advanced open-angle glaucoma were treated with trabeculectomy and tenoneetomy （excision of tenon＇ s capsule ）, combined with biological amniotic membrane transplantation under scleral flap. The patients were followed up for 6 to 18 months. Visual acuity, intraocular pressure, fundus and the type of blebs were recorded. Results There was no decrease of visual acuity or severe postoperative complications after surgery. Average intraoeular pressure （IOP） was reduced from （33.50±5.50） mmHg preoperatively to （11.80 ± 3.50） mmHg postoperatively （1 mmHg =0. 133 kPa） 1 week after surgery （t =65.86,P 〈0.05）. Functional filter bleb formed in 80.65% （25/31） of patients 18 months after the operation. The complete success rate and conditional success rate were 69.23% （45/65） and 24.62% （ 16/65 ） respectively. Conclusion The combined surgery of ocular tenonectomy, trabeculectomy and amniotic memebrane transplantation for treatment of open-angle glaucoma may be safe and efficient.