生物羊膜或交联透明质酸钠在青光眼小梁切除术中的应用

Application of amniotic membrane or cross-linked sodium hyaluronate in trabeculectomy

目的评估小梁切除术联合生物羊膜植入或联合交联透明质酸钠植入术治疗原发性青光眼的有效性.方法回顾性研究,抽取该院2016年5月至2018年6月原发性青光眼92例(97眼)分成3组.生物羊膜植入术组(羊膜组)30例(32眼)行小梁切除联合生物羊膜植入术;交联透明质酸钠植入组(交联组)32例(35眼)行小梁切除联合交联透明质酸钠植入术;对照组30例(30眼)行常规小梁切除术.术后随访1年,评估其效果.结果术后1年羊膜组和交联组平均眼压均低于对照组,差异均有统计学意义(P=0.00,0.00);术后1周浅前房发生率3组间比较,差异无统计学意义(F=2.230,P=0.328).术后1年功能性滤过泡三组间差异有统计学意义(P<0.05).羊膜组与对照组相比,差异有统计学意义(P=0.016);交联组与对照组、羊膜组与交联组相比差异无统计学意义(P=0.028,0.543).结论小梁切除联合生物羊膜植入术与联合交联透明质酸钠植入术能有效降低眼压,抑制滤过泡瘢痕形成.应用生物羊膜降眼压效果较好,交联透明质酸钠能显著降低浅前房的发生率.

Objective To evaluate the clinical efficacy of trabeculectomy combined with implantation of biologic amniotic membrane or cross-linked sodium hyaluronate for the treatment of primary glaucoma.Methods A retrospective study.Total of 97 eyes of 92 cases with primary glaucoma from May 2016 to Jun.2018 in this hospital were randomly divided into three groups.Group A,32 eyes of 30 cases,were treated with trabeculectomy combined with biologic amniotic membrane implantation;group B,35 eyes of 32 cases,were treated with trabeculectomy combined with cross-linked sodium hyaluronate implantation,and the control group,30 eyes of 30 cases,were treated with trabeculectomy.All cases were followed up for 1 year.The efficacy were evaluated.Results The average intraocular pressure at 1 year after operation in group A and group B were lower than that of control group(P=0.00,0.00).There was no significant difference in the rate of shallow anterior chamber among the three groups at 1 week after operation(F=2.230,P=0.328).One year after operation,the difference of functional filtering blebs rate was statistically significant among three groups.The difference was statistically significant between group A and the control group(P=0.016).There was no significant difference between group A and group B(P=0.543).The difference was not statistically significant between group B and control group(P=0.028).Conclusion Trabeculectomy combined with biological amniotic membrane implantation or cross-linked sodium hyaluronate implantation can safely and effectively reduce intraocular pressure and inhibit the formation of filtering bleb scar.Amniotic membrane has better effect in reducing intraocular pressure.The cross-linked sodium hyaluronate can significantly reduce the incidence of shallow anterior chamber.