穿刺切口青光眼手术(SIGS)治疗成人青光眼的临床观察

Clinical observation on the treatment of adult glaucoma by stab incision glaucoma surgery

目的:观察穿刺切口青光眼手术(SIGS)治疗成人青光眼的安全性和有效性。方法:回顾性系列病例研究。收集2018-06/2020-11在我院实施SIGS治疗的青光眼患者55例70眼的临床资料,随访至术后6mo,观察眼压、滤过泡及术后并发症情况。结果:纳入患者中30眼行单纯SIGS,40眼行SIGS联合白内障手术,其中33眼(47%)手术完全成功,28眼(40%)手术部分成功,9眼(13%)手术失败。术前用药情况下平均眼压31.82±13.16mmHg,术后1wk,1、3、6mo平均眼压(14.97±5.25、17.94±5.24、18.43±4.74、17.37±3.36mmHg)均较术前明显降低,且术后6mo降眼压药物使用数量[0(0,1)]种较术前[3(2,3)]明显减少(P<0.001)。术后6mo,纳入患者滤过泡形态Ⅰ型(功能性滤过泡)30眼(43%),Ⅱ型(功能性滤过泡)31眼(44%),Ⅲ型(扁平滤过泡)7眼(10%),Ⅳ型(包裹性囊状泡)2眼(3%)。随访期间,2眼前房积血,4眼前房炎症反应,3眼低眼压、浅前房、滤过过甚,1眼恶性青光眼,1眼眼内炎,1眼脉络膜脱离,1眼睫状体脱离,9眼滤过泡瘢痕化。结论:SIGS治疗原发性开角型青光眼、原发性闭角型青光眼及部分继发性青光眼降眼压效果良好,且无严重并发症。

·AIM:To observe the safety and efficacy of stab incision glaucoma surgery(SIGS)in the treatment of adult glaucoma.·METHODS:A series of retrospective case studies were carried out from June 2018 to November 2020,the clinical data of 55 cases with 70 eyes of glaucoma treated with SIGS in our hospital were collected.Following up at 6mo after operation,the intraocular pressure(IOP),bleb and postoperative complications were observed.·RESULTS:Among the included patients,30 eyes were performed SIGS alonely,40 eyes were performed SIGS combined with phacoemulsification.Among them,the operation of 33 eyes(47%)was completely successful,the operation of 28 eyes(40%)was partially successful,and the operation of 9 eyes(13%)were failed.The mean preoperative IOP under medication was 31.82±13.16mmHg,and at 1wk,1,3 and 6mo after operation,the mean IOP(14.97±5.25,17.94±5.24,18.43±4.74,17.37±3.36)mmHg were all significantly lower than before operation,and the number of IOP-lowering drugs used at 6mo after operation[0(0,1)]was significantly lower than before operation[3(2,3)](P<0.001).At 6mo after operation,the filtering blebs’shape of the patients:30 eyes(43%)of type I(functional bleb),31 eyes(44%)of typeⅡ(functional bleb),7 eyes(10%)of typeⅢ(flat bleb)and 2 eyes(3%)of type IV(encapsulated vesicular bleb)were included.During the follow-up period,2 eyes had hyphema in anterior chamber,4 eyes had inflammatory reaction in anterior chamber,3 eyes had low IOP,shallow anterior chamber and excessive filtration,1 eye had malignant glaucoma,1 eye had endophthalmitis,1 eye had choroidal detachment,1 eye had choroidal detachment,and 9 eyes had scarring of filtering blebs.·CONCLUSION:SIGS is effective in the treatment of primary open angle glaucoma,primary angle-closure glaucoma and some secondary glaucoma without serious complications.