角膜缘为基底结膜瓣筋膜的垂直切开可调节线小梁切除术探讨

Discussion of vertical incision of adjustable sature trabeculectomy with corneal limbus as basalconjunctival flap

目的探讨以角膜缘为基底结膜瓣筋膜的垂直切开可调节线小梁切除术的效果。方法262例(400只患眼)青光眼患者,依据手术方法不同分为实验组(132例,200只患眼)与对照组(130例,200只患眼)。对照组以穹隆为基底结膜瓣进行小梁切除术,实验组则以角膜缘为基底结膜瓣进行小梁切除术。术后随访6~12个月,对比两组术后结膜切口渗漏、滤过泡、眼压、前房深度、术后视力、前房积血及脉络膜脱离发生情况。结果实验组结膜切口渗漏率12.00%低于对照组的0,差异具有统计学意义(P<0.05)。实验组Ⅰ、Ⅱ型滤过泡占比高于对照组,差异具有统计学意义(P<0.05)。实验组术后低眼压发生率0.50%低于对照组的9.00%,差异具有统计学意义(P<0.05)。两组术后Ⅰ度浅前房发生率对比,差异无统计学意义(P>0.05)。实验组中129只患眼术后视力提高1行以上,对照组中62只患眼术后视力提高1行以上,观察期内无一例术后视力下降;实验组术后视力提高1行以上占比高于对照组,差异具有统计学意义(P<0.05)。两组脉络膜脱离发生率对比,差异无统计学意义(P>0.05)。实验组前房积血发生率低于对照组,差异具有统计学意义(P<0.05)。结论以角膜缘为基底结膜瓣筋膜垂直切开可调节线小梁切除术治疗效果更佳、安全性高、滤过泡形成更好,适用于各型青光眼。为防止角膜缘切口渗漏,应优先选择以角膜缘为基底结膜瓣筋膜垂直切开可调节线小梁切除术。

Objective To discuss the effect,complications and indications of vertical incision of adjustable sature trabeculectomy with corneal limbus as basal conjunctival flap.Methods A total of 262 patients(400 involved eyes)were divided into experimental group(132 cases,200 involved eyes)and control group(130 cases,200 involved eyes).The control group used trabeculectomy with fornix as basal conjunctival flap,and the experimental group used trabeculectomy with corneal limbus as basal conjunctival flap.After 6-12 months of follow-up,the conjunctival incision leakage,filtering bleb,intraocular pressure,anterior chamber depth,postoperative visual acuity,and occurrence of anterior chamber hemorrhage and choroidal detachment were compared between the two groups.Results The conjunctival incision leakage rate 12.00%of the experimental group was lower than 0 of the control group,and the difference was statistically significant(P<0.05).The proportions of typeⅠand typeⅡfiltering bleb of the experimental group were higher than those of the control group,and the difference was statistically significant(P<0.05).The incidence of postoperative hypotony 0.50%of the experimental group was lower than 9.00%of the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in incidence of gradeⅠshallow anterior chamber between the two groups(P>0.05).The postoperative visual acuity of 129 eyes in the experimental group improved by more than 1 line,and the postoperative visual acuity of 62 eyes in the control group improved by more than 1 line.No postoperative visual acuity decreased during the observation period.The proportion of postoperative visual acuity improved by more than 1 line of the experimental group was higher than that of the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in incidence of choroidal detachment between the two groups(P>0.05).The incidence of anterior chamber hemorrhage of the experimental group was lower than that of the control group,and the difference was statistically significant(P<0.05).Conclusion Vertical incision of adjustable sature trabeculectomy with corneal limbus as basal conjunctival flap has better therapeutic effect,high safety,and better filtering bleb formation.It is suitable for all types of glaucoma.In order to prevent conjunctival incision leakage,the vertical incision of adjustable sature trabeculectomy with corneal limbus as basal conjunctival flap should be selected first.