青光眼小梁切除联合羊膜植入或引流器植入术

Trabeculectomy combined with implantation of amniotic membrane or glaucoma drainpipe implants for glaucoma

目的探讨小梁切除术联合生物羊膜植入或联合引流器植入术治疗原发性青光眼的效果及并发症。方法原发性青光眼125例（150眼）随机分成3组。生物羊膜植入术组（羊膜组）46例（54眼）行小梁切除联合生物羊膜植入术；引流器植入术组（引流器组）40例（52眼）行小梁切除联合引流器植入术；对照组：39例（44眼）行常规小梁切除术。术后随访1年，观察3组术后眼压、滤过泡形态及并发症的情况。结果术后1周平均眼压：羊膜组为（13．76±0．81）mmHg（1mmHg=0．133kPa），引流器组为（12．54±0．47）mmHg，对照组为（14．45±0．37）mmHg，组间差异无统计学意义（F=1．07，P=0．22）。术后1年平均眼压：羊膜组为（11．81±0．74）mmHg，引流器组为（11．75±0．25）mm．Hg，此两组问差异无统计学意义（P=0．06）；但两组分别均低于对照组的（14．90±0．82）mmHg，差异均有统计学意义（P=0．01，P=0．04）。术后1周浅前房羊膜组6眼（11．11％）、引流器组7眼（13．5％），对照组5眼（11．9％）。术后1年功能性滤过泡：羊膜组为92．6％，引流器组为94．2％，对照组为65．9％为功能性滤过泡。结论小梁切除联合生物羊膜植入术与联合引流器植入术均能安全、有效地降低眼压，抑制滤过道瘢痕形成。

Objective To study the clinical effects and complications of the trabeculectomy combined with implantation of biologic amniotic membrane or glaucoma drainpipe implants for the treatment of primary glaucoma. Methods One hundred and fifty eyes of 125 cases with primary glaucoma were randomly divided into three groups. Patients in the amnion group （54 eyes of 46 cases） were treated with ordinary trabeculectomy combined with biologic amniotic membrane, Patients in the drainage group （52 eyes of 40 cases） were treated with trabeculectomy combined with glaucoma drainage implants, and patients in control group（44 eyes of 39 cases） were treated with ordinary trabeculectomy. Patients were followed up for one year. The post-operative intraocular pressure （lOP）, filtration bleb and complications were observed. Results One week after operation, lOP of the amnion group was （ 13.76 ±0.81 ） mmHg（ 1 mmHg =0. 133 kPa）, lOP of the drainage group was （ 12.54 ±0.47） mmHg, lOP of the control group was （ 14.45 ±0.37） mmHg and the difference was not statistically significant （ F = 1.07, P = 0.22）. One year after operation, lOP of the amnion group was （ 11.81 ± 0.74） mmHg, 10P of the drainage group was （ 11.75 ± 0.25 ） mmHg and the difference was not statistically significant （ P = 0.06 ）. 10P of the control group was （ 14, 90 ±0.62 ） mmHg which was higher than that of the other two groups and the difference was statistically signieant compared with that of the other two groups （ F = 0. 01, P = 0.04）. One week after operation, shallow anterior chamber happened in 6 eyes in the amnion group, 7 eyes in the drainage group and 5 eyes in control group. One year after operation, the percentage of functional filtration bleb was 92.6% in the amnion group,94.2% in the drainage group and 65.9% in control group respectively. Conclusion The trabeculectomy combined with biologic amniotic membrane or glaucoma drainpipe implants can reduce the IOP safely and effectively, and inhibit filtering bleb cicatrization.