缝线植入Schlemm管开口部成形联合小梁切除术治疗原发性开角型青光眼三年疗效观察

Effect of suture canalization on the treatment of primary open-angle glaucoma： 3 years clinical observation

目的研究缝线植入Schlemm管开口部成形联合小梁切除术治疗POAG的临床安全性和有效性。方法回顾性系列病例研究。收集温州医科大学附属眼视光医院2007年10月至2009年7月52例（52只眼）POAG患者的临床资料，其中26例（26只眼）行缝线植入Schlemm管开口部成形联合小梁切除术（联合手术组）；26例（26只眼）行复合式小梁切除术（小梁切除组）。术后1d、1周、1个月、3个月、6个月、12个月、18个月、24个月、30个月、36个月作为随访时间点，观察最佳矫正视力、眼压、滤过泡的形态、术后用药及术中、术后并发症。多组计量资料收据进行正态性和方差齐性检验后采用方差分析，两两比较采用t检验。计数资料采用卡方检验，非正态分布变量的组间比较应采用秩和检验。结果术前联合手术组与小梁切除组的基线资料差异均无统计学意义。末次随访时：联合手术组与小梁切除组最佳矫正视力变化比较差异无统计学意义（χ2=3．06，P=0．08）；联合手术组完全成功率为69．2％（18／26），小梁切除组完全成功率为61．5％（16／26），组间比较差异无统计学意义（χ2=0．34，P=0．56）；联合手术组条件成功率为88．5％（23／26），小梁切除组条件成功率为84．6％（22／26），组间比较差异无统计学意义（χ2=0．17，P=0．69）。联合手术组术前眼压、末次随访眼压分别为（32．4±9．3）、（16．9＋3．5）mmHg（1mmHg=0．133kPa），小梁切除组术前眼压、末次随访眼压分别为（31．3±10．0）、（15．5±4．6）mmHg，两组术后末次随访眼压与术前眼压相比差异均有统计学意义（试验组：t=8．12，P〈0．叭；小梁切除组：t=7．20，P〈0.01）；末次随访时试验组与小梁切除组降压幅度分别为（15．5±9．7）mmHg与（15．8±11．2）mmHg，差异无统计学意义（t=0．23，P=0．63）。术后不同随访时间点，两种手术方式眼压差异不具有统计学意义（P〉0．05）。末次随访时试验组中有65．4％患者中形成了功能性滤过泡（微囊型＋弥散型）；小梁切除组中有61．5％患者中形成了功能性滤过泡（微囊型＋弥散型）；联合手术组功能性滤过泡（微囊型＋弥散型）患者末次随访眼压为（15．5±3．5）mmHg，非功能性滤过泡患者末次随访眼压为（16．0±3．4）mmHg，差异无统计学意义（t=-0．49，P=0．64）。两组术中、术后无严重并发症的发生。末次随访时2组使用抗青光眼药物的种数差异无统计学意义（t=2．93，P=0．09）。结论缝线植入Sehlemm管开口部成形联合小梁切除术具有Schlemm管和外滤过双重引流通道，是一种安全、有效地降低POAG眼压的手术方法。术中并发症少。

Objective To evaluate the safety and effectiveness of the Suture Canalization, which is a kind of Sehlemm canal surgery, on the treatment of patients with primary open angle glaucoma （POAG）. Methods Retrospective cases series study. Fifty-two patients （52 eyes） with POAG were recruited from October 2007 to July 2009 from Hospital of Optometry and Ophthalmology, Wenzhou Medical University. Twenty-six patients （26 eyes） were included in the study group, who were treated with the Suture Canalization surgery with trabeculectomy. Twenty-six patients （26 eyes） were included as the control group, who were treated with trabeculectomy only. Best correct visual acuity （BCVA）, mtraocular pressure （IOP）, bleb morphology, postoperative treatment of medicine of anti-glaucoma and complications of surgery were recorded at 1 d, 1 week, 1, 3, 6, 12, 18, 24, 30 and 36 months after surgery. After testing the normality and homogeneity of variance of the data of the multiple sets of measurement data, the variance analysis was adopted, and the t test was used in the comparison of two groups. Counting data using chi-square test, the level of variables between the groups should be compared with the rank sum test. Results No significant difference was found in baseline data, as well as the changes of BCVA between the study group and control group at the last visit（χ2=3.06,P=0.08）. Complete and qualified success was achieved in 18 （69.2%） and 23 （88.5%） cases separately in study group, 16 （61.5%） and 22 （84.6%） cases separately in control group （χ2= 0.17, P=0.69）. There was no significant difference between two groups. IOP was decreased post-operatively： from （32.4±9.3） mmHg（1 mmHg=0.133 kPa）to （16.9±3.5） mmHg at the last visit in study group and （31.3± 10.0） mmHg to （15.5±4.6） mmHg at the last visit in control group. There were significant difference between last visit and preoperative IOP between two groups （study group： t=8.12, P〈0.01 ; control group： t=7.20, P〈 0.01）. No significant difference was found between two groups in the decreased amplitude of IOP with treatment at the last visit （t=0.23, P=0.63）, as well as the postoperative IOP at the different visits （P〉0.05）. 65.4% of cases in the study group and 61.5% patients in control group formed functional blebs （diffuse type and microcapsule type） at the last visit. No significant difference between the IOP of patients with functional blebs （15.5±3.5） mmHg and those with non-functional blebs （16.0±3.4） mmHg in study group at the last visit （t=-0.49, P=0.64）. No serious complications during and after surgery were found in subjects of the both groups. No significant difference was present in medicine amounts at last visit between the two groups （t= 2.93, P=0.09）. Conclusions Suture Canalization is a safe and effective surgical procedure to decrease intraocular pressure in patients with POAG, through Schlemm canal and external filtration. While it maybe not suitable to the patient with high pre-operative IOP.