国产眼科光纤导管在穿透性黏小管成形术中应用的六个月效果

Six-month efficacy of application of domestic illuminated microcatheter on penetrating canaloplasty

目的观察国产眼科光纤导管在穿透性黏小管成形术中初步应用的安全性和有效性。设计前瞻性病例系列。研究对象 2018年5月至2018年8月温州眼视光医院接受国产眼科光纤导管进行穿透性黏小管成形术治疗的青光眼患者30例(30眼)。方法使用国产眼科光纤导管进行黏小管成形术,于角巩膜缘床开窗进入前房,使房水可以直接经巩膜瓣下进入Schlemm管断端开口,术中不使用抗代谢药物,术末紧密缝合巩膜瓣。术后随访6个月。术后使用降眼压药物下眼压≤21 mmHg为条件成功,不使用任何降眼压药物眼压≤21 mmHg为完全成功。主要指标 Schlemm管穿通率、眼压、降眼压药物数量、手术成功率、并发症。结果 23眼(76.7%)完成了360°Schlemm管穿通。术前平均眼压(34.3±13.9)mmHg,术后1天、1周、1、3和6个月的平均眼压分别为(15.0±9.7)mmHg、(17.3±8.8)mmHg、(15.6±3.7)mmHg、(13.9±6.1)mmHg和(13.4±3.3)mmHg(P<0.001);术前平均用药为(3.4±1.2)种,术后1天、1周、1、3和6个月的平均用药分别为(0.2±0.9)种、(0.5±0.9)种、(0.2±0.5)种、(0.1±0.2)种和(0.2±0.5)种(P<0.05)。术后6个月条件成功率和完全成功率分别为95.0%(19/20)和85.0%(17/20)。 4眼(18.2%)出现前房积血,其中1眼(4.5%)伴有一过性低眼压和I级浅前房。术后6个月95%(19/20)在裂隙灯下未见明显滤过泡。9眼(40.9%)出现术后一过性高眼压。结论随访6个月的结果表明,国产眼科光纤导管在穿透性黏小管成形术中的Schlemm管穿通率约为四分之三。手术成功者6个月随访期间眼压明显下降,且滤过泡发生率低。但其远期疗效仍需更长时间的随访观察。

Objective To observe the preliminary application of the domestic illuminated microcatheter on penetrating canaloplasty. Design Prospective case series. Participants 30 cases (30 eyes) of glaucoma patients were treated with the penetrating canaloplasty from May 2018 to August 2018 in Eye Hospital of Wenzhou Medical University. Methods A window at the corneal-scleral bed after the canaloplasty using the domestic illuminated microcatheter was made, enabling aqueous to redirect into the opening of schlemm canal with intension sutures. No antimetabolite agents were used in the surgical procedure. Time points of follow-up were arranged at 1 day, 1 week, 1, 3 and 6 months after the surgery. Qualified success was defined as intraocular pressure (IOP)≤21 mmHg with medication. Complete success was defined as IOP≤21 mmHg without medication. Main Ooutcome Measures Rate of circumferential catheterization of the canal, IOP, number of medication, surgical success rate and complications. Results 23 eyes (76.7%) achieved the 360 degrees’ catheterization of the canal. The mean preoperative IOP was (34.3±13.9) mmHg. The mean IOP at 1 day, 1 week, 1, 3 and 6 months after the surgery was (15.0±9.7) mmHg,(17.3±8.8) mmHg,(15.6±3.7) mmHg,(13.9±6.1) mmHg and (13.4±3.3)mmHg, respectively (P<0.001). The mean number of preoperative medication was 3.4±1.2. The mean number of postoperative medication was 0.2±0.9, 0.5±0. 9, 0.2±0.5, 0.1±0.2 and 0.2±0.5, respectively (P<0.05). Surgical success rate at 6 month after surgery was 95.0%(19/20)(qualified success) and 85.0%(17/20)(complete success), respectively. With regard to complications, hyphema was observed in 4 eyes(18.2%), meanwhile hypotony and grade Ⅰ shallow anterior chamber was observed in one of the eyes(4.5%). No filtering bleb was observed in 19 eyes (95.0%) at 6-month after the surgery. Additionally,transient elevated IOP was observed in 9 eyes (40.9%). Conclusion The result of six-month follow-up shows the domestic illuminated microcatheter can achieve about 75% success rate of circumferential catheterization in the procedure of penetrating canaloplasty. Obvious IOP reduction and few filtering blebs were observed. Longer-term follow-up is required.