小梁组织切除与否对青光眼小梁切除术后疗效的影响

Comparison of Postoperative Roles of Diferent Tissue Resection Under Sceral Flap in Trabeculectomy

目的评价原发性慢性闭角型青光眼小梁切除术中小梁组织切除与否的临床疗效。方法对2016年9月~2017年5月在我院行小梁切除术的原发性慢性闭角型青光眼患者30例(32眼)进行回顾性分析,分析常规小梁切除术后的组织切片结果。根据结果分为小梁切除眼组和巩膜切除眼组。术后常规随访1周~12个月,主要观察患者的眼压及有无脉络膜脱离等情况。比较有无切除小梁组织对原发性慢性闭角型青光眼术后疗效的影响。结果 32眼均经病理检查,其中11眼(34.4%)可见到小梁组织和Schlemm管,为小梁切除眼组;21眼(65.6%)仅见巩膜组织,为深层巩膜切除眼组。两组手术后均能降低眼压,手术前后眼压差异具有显著性(t=9.2145,P<0.05)。术后随访各时间点,两组间眼压差异无显著性(P>0.05)。术后随访,巩膜切除眼组发生脉络膜脱离3眼,小梁切除眼组没有发生脉络膜脱离,组间差异具有显著性(χ2=0.3319,P<0.05)。结论小梁切除与否对原发性慢性闭角型青光眼小梁切除术后的降眼压效果无影响,但无小梁组织切除眼术后脉络膜脱离的发生率明显高于小梁组织切除眼。

Objective To evaluate clinical efficacies of diferent resection tissue under scleral flap in trabeculectomy for the primary chronic angle closure glaucoma（ PCACG）. Methods Thirty cases（ 32 eyes） of trabeculectomy for the PCACG in our hospital from September 2016 to May 2017 were reviewed retrospectively. Regular histological analysis of paraffin section after trabeculectomy. According to the results of histological section,32 eyes were divided into trabecular meshwork resection（ TMR） group and deep sclera resection（ DSR） group. Intraocular pressure（ IOP） was measured pre-and post-operatively by Goldmann tonometer. Postoperative choroidal detachment was recorded with B-scan. All cases were followed-up for 6 months. Results Schlemm＇s canal and trabecular meshwork was seen in 11 eyes（ 34. 4%）in a regular histological section after trabeculectomy. Only deep sclera was seen in 21 eyes（ 65. 6%） in the section. IOP was reduced in both groups after trabeculectomy,the IOP difference between pre-and post postoperation was statistically significant（ t = 9. 2145,P〈0. 05）. From 1 weeks to 6 months of postoperation,compared IOP between two groups,there was no statistically significant difference（ P〉0. 05）. Postoperative choroidal detachment was recorded in 3 cases（ 34.4%） in DSR group,and 0 case in TMR group. Compared the incidence rate of choroidal detachment between two groups,there was no statistically significant difference（ χ^2 = 0. 3319,P〈0. 05）. Conclusion IOP is reduced significantly after trabeculectomy in TMR group and DSR group. But the incidence rate of choroidal detachment is higher in DSR group than that in TMR group.