小梁切除术与青光眼阀植入术治疗原发性开角型青光眼的对照研究

Comparison of the clinical efficacy between Ahmed glaucoma valve implantation andtrabeculectomy in patients with primary open angle glaucoma

目的:比较小梁切除术与青光眼阀植入术两种不同的抗青光眼手术方式治疗原发性开角型青光眼的临床疗效。方法:回顾性分析原发性开角型青光眼患者45例58眼,其中24例32眼接受穿透性小梁切除术(A组),另21例26眼接受青光眼阀植入术(B组)。比较两组术后眼压、视力、视野及并发症情况。结果:(1)眼压:A组术后2d;1,2wk;1,3,6mo眼压分别为13.56±4.91mm Hg(1mm Hg=0.133k Pa),14.47±4.03,17.56±5.74,18.25±5.49,18.13±4.24,19.68±4.55mm Hg;B组术后2d;1,2wk;1,3,6mo眼压分别为13.58±4.16,16.00±4.83,18.00±5.05,19.42±5.41,18.42±3.37,20.00±5.37mm Hg,两组患者术后各时间点眼压无统计学差异(P>0.05);(2)视力:术后随访6mo,A组视力下降者7眼(22%);B组视力下降者5眼(19%),两组患者术后视力检查无统计学差异(χ2=0.061,P>0.05);(3)视野:术后随访6mo,A组视野缩小者13眼(41%);B组视野缩小者10眼(38%)。两组患者术后视野检测无统计学差异(χ2=0.028,P>0.05);(4)并发症:术后随访6mo,A组浅前房4眼,并发性白内障4眼,后弹力层脱离1眼;B组浅前房1眼,并发性白内障1眼。两组间差异有统计学意义(χ2=4.144,P<0.05);(5)手术成功率:术后6mo,完全手术成功率:A组37%(12眼),B组35%(9眼)。部分手术成功率:A组19%(6眼),B组15%(4眼),两组间差异无统计学意义(χ2=0.225,P>0.05)。结论:青光眼阀植入术与小梁切除术均是治疗原发性开角型青光眼的有效手段,两者临床疗效并无明显差异。但青光眼阀植入术安全性较高,术后合并症较少。

AIM： To compare clinical efficacy between Ahmed glaucoma valve implantation and trabeculectomy in patients with primary open angle glaucoma （ POAG） . METHODS： This retrospective study included 58 eyes from 45 patients with primary open angle glaucoma. And 32 eyes underwent penetrating trabeculectomy （ group A）, while 26 eyes were performed Ahmed glaucoma valve implantation （ group B） . lntraocular pressure （ IOP） , best-corrected visual acuity （ BCVA ） , visual field and post-operative complications were observed between these two groups. RESULTS：（1） IOP：the IOP of post-operation in group A were （13. 56±4. 91）, （14. 47±4. 03）, （17. 56±5. 74）, （18. 25±5. 49）, （18. 13±4. 24）, （19. 68±4. 55） mm Hg at 2d, 1, and 2wk, 1, 3 and 6mo respectively; and that were （13.58±4. 16）, （16. 00±4. 83）, （18. 00±5. 05）, （19. 42±5. 41）, （18. 42±3. 37）, （20. 00±5. 37） mm Hg in group B. There was no statistically significant difference in IOP between the two groups （ P〉 0. 05 ）. （ 2 ） BCVA： the number of visual acuity decreased eyes, with 6mo follow-up, was 7 （22%） in group A; and that was 5 in group B （19%）. There was no statistically significant difference in vision loss postoperatively between the two groups （χ2=0. 061, P〉0. 05）. （3） Visual field： with 6mo follow-up,there were 13 eyes （ 41%） which had constricted visual field in group A, while those were 10 eyes （38%） in group B; the difference of visual field loss between the two groups was not statistically significant （χ2 = 0. 028, P〉0. 05 ） . （ 4 ） Complications： six-month follow-up after operation, there were 4 eyes with shallow anterior chamber, 4 eyes with complicated cataract and 1 eyes with Descemet’s membrane detachment in group A, while that was 1 eyes with shallow anterior chamber and 1 eyes with complicated cataract in group B; there was statistically significant difference in the rate of complications between the two groups （χ2 = 4. 144, P〈0. 05 ） . （ 5 ） Surgical success rate： six month after operation, the completed success rate was 37% （12 eyes） in group A, and that was 35% （9 eyes） in group B. The partial success rate was 19% （6 eyes） and 15% （4 eyes） in group A and group B respectively. The difference of success rates between the two groups was not statistically significant （χ2=0. 225, P〉0. 05）. CONCLUSION： Both Ahmed glaucoma valve implantation and trabeculectomy are effective methods for the treatment of POAG. The clinical efficacy was no difference between the two methods. However, compared with trabeculectomy, Ahmed glaucoma valve implantation was safer and had fewer complications.