小梁切除联合Schlemm管外壁切除术治疗晚期青少年型青光眼的效果

Observation on the efficacy of trabeculectomy combined with resection of external wall of Schlemm’s canal for the treatment of advanced juvenile glaucoma

目的:评价小梁切除联合Schlemm管外壁切除术治疗晚期青少年型青光眼的效果。方法:回顾性研究。收集2018年10月至2020年2月就诊于郑州大学第一附属院眼三科晚期青少年型青光眼40例(66眼)的临床资料。患者分成两组:A组,19例(33眼),接受小梁切除联合Schlemm管外壁切除术;B组,21例(33眼),接受小梁切除手术。随访12个月,对比两组手术前后视力、眼压视野及视神经纤维层厚度。结果:术后12个月,两组视力、平均视野缺损值(MD)及视网膜神经纤维层(RNFL)厚度分别与术前相比差异均无统计学意义(P>0.05)。两组术后各随访时间点眼压均较术前下降(P<0.05)。术后1周、1、3、6及12个月眼压A组低于B组(P<0.05)。两组术中及术后均无脉络膜上腔出血、低眼压性黄斑水肿或眼内炎等严重并发症发生。结论:小梁切除联合Schlemm管外壁切除术是治疗晚期青少年型青光眼的一种安全有效的手术方式。

Objective To evaluate the efficacy of trabeculectomy combined with resection of external wall of Schlemm’s canal in the treatment of advanced juvenile glaucoma.Methods The clinical data of 66 eyes of 40 cases with juvenile glaucoma from Oct.2018 to Feb.2020 were retrospectively analyzed.All cases were divided into two groups.Thirty-three eyes of 19 cases in group A received trabeculectomy combined with Schlemm’s canal resection,and 33 eyes of 21 cases in group B received trabeculectomy only.Postoperative follow-up time was 12 months.The visual acuity,IOP,visual field and retinal nerve fiber layer(RNFL)thickness before and after surgery were compared between the two groups.Results There was no significant difference in visual acuity,mean defect of visual field(MD)value or average RNFL thickness in the two groups before and 12 months after surgery(P>0.05).The intraocular pressure at each follow-up time point after operation in the two groups were lower than that before operation,and the difference were statistically significant(P<0.05).The IOP in group A was lower than that in group B at every follow-up time point.There were significant differences in intraocular pressure between the two groups at 1 week,1,3,6 and 12 months after operation(P<0.05).There were no severe complication such as suprachoroidal hemorrhage,hypotension macular edema or endophthalmitis in both groups during and after operation.Conclusion Trabeculectomy combined with resection of external wall of Schlemm’s canal for the treatment of advanced juvenile glaucoma can effectively control the intraocular pressure and protect visual function.