睫状体平坦部滤过术与小梁切除术治疗新生血管性青光眼的比较

Comparison of pars plane filtering surgery versus trabeculectomy in neovascular glaucoma

目的:比较睫状体平坦部滤过术(PPF)和小梁切除术(TRA)治疗新生血管性青光眼(NVG)的安全性和有效性。方法:回顾性分析2020-04/2021-04在我院治疗的NVG患者27例27眼,将行睫状体平坦部滤过术的患者12例12眼纳入PPF组,行小梁切除手术的患者15例15眼纳入TRA组。随访至术后3mo,观察患者的眼压、手术完全成功率、周边前房深度、术后前房形态改变、视力及并发症情况。结果:术后1、3d,1wk,1、3mo两组患者眼压均较术前显著降低(P<0.05),但两组间眼压无差异(P>0.05)。术后3mo,PPF组手术完全成功率显著高于TRA组(92%vs 53%,P<0.05)。术后1wk,PPF组周边前房深度较术前显著加深(P<0.05),TRA组周边前房深度较术前无显著改变(P>0.05),但PPF组周边前房深度较TRA组显著加深(P<0.05)。PPF组术后房角开放、前房加深。两组患者术前和术后3mo视力均无差异(P>0.05),且两组术后3mo视力较术前均无显著改变(P>0.05)。PPF组术后前房出血发生率低于TRA组(8%vs 47%,P<0.05)。结论:PPF和TRA手术均能有效降低和稳定NVG患者的眼压,但PPF术显示更高的手术完全成功率,并能加深周边前房,术后严重并发症较少。

AIM:To compare the safety and effectiveness of pars plane filtering(PPF)and trabeculectomy(TRA)on neovascular glaucoma(NVG).METHODS:This retrospective comparison was done in 12 patients(one eye with NVG in each)who were treated with PPF surgery and 15 patients who were treated during the same period with TRA,one eye was treated in each patient.Intraocular pressure(IOP),complete surgical success rate,peripheral anterior chamber depth(PACD),postoperative anterior chamber morphology,visual acuity and complications were observed and compared between the two groups.RESULTS:The IOP was significantly reduced at each time point after the surgery 1,3d,1wk,1,3mo after operation(P<0.05),and there was no significant between-group difference at any time point(P>0.05).The rate of complete success observed 3mo after operation was superior in PPF group(92%vs 53%,P<0.05).PACD was found to be deeper at 1wk after the operation in PPF group as compared with the values before the operation and was deeper than that in TRA group(P<0.05);while this comparison in TRA group showed no significant change(P>0.05).After the operation,the anterior chamber angle was open and the anterior chamber was deepened in PPF group.No significant changes in visual acuity before and after the operation within each group and between groups were observed 3mo after the surgery(P>0.05).The incidence of postoperative hemorrhage in anterior chamber was lower in PPF group(8%vs 47%,P<0.05).CONCLUSION:Both PPF and TRA surgery can successfully control IOP of NVG.However,PPF surgery appeared to be superior as having a higher complete success rate.In addition,PPF surgery makes the anterior chamber deeper and wider,and result in fewer severe postoperative complications.