Schlemm管缝线植入联合小梁切除术治疗原发性闭角型青光眼

A combined surgery of schlemm's canal suture implantation and trabeculectomy to primary closed-angle glaucoma

目的 探讨 Schlem m管缝线植入联合小梁切除术治疗原发性闭角型青光眼的临床疗效。方法 对原发性闭角型青光眼 15例 16眼 ,其中急性闭角型 11例 11眼 ,慢性闭角型 4例 5眼的患者施行了 Schlem m管缝线植入联合小梁切除术。按照风间成泰的手术方法是做二层巩膜瓣并切除深层巩膜瓣 ,剪除 Schlemm管外壁 ,并从管断端口分别植入Schlemm管内 6 - 0尼龙线 6～ 8mm ,穿透性小梁切除及相应虹膜剪除 ,水密缝合浅层巩膜瓣。术后观察眼压、前房形成、眼内炎性反应、视力、术后并发症以及有无滤过泡等情况。随访 3～ 10个月 ,平均 (6 .95± 2 .73)个月。结果 患者术前平均眼压 (30 .2 5± 16 .33) m m Hg(1k Pa=7.5 mm Hg) ,术后 3、6、9个月平均眼压分别为 (18.0 1± 5 .4 4 )、(16 .92± 5 .2 4 )、(16 . 33± 0 .6 5 ) mm Hg,差异有非常显著性 (t值分别为2 .74 0、3.0 2 4、3.399,P值分别为 0 .0 13、0 .0 0 7、0 .0 0 4 )。术前平均用药 (2 .5 0± 1.33)种。随访期间眼压≤ 2 1mm Hg14眼(87.5 % )。术后 8眼 (40 % )有少量前房积血 ,大部分 3～ 5 d吸收。 2眼有前房内有形渗出 ,5 d消失。 3眼形成滤过泡 ,其他眼随访未形成滤过泡。无脉络膜脱离、持续性低眼压等并发症发生。结论

Objective To study the clinical effectiveness of schlemm's canal suture implantation and trabeculectomy to primary and closed angle glaucoma.Methods We operated on 16 eyes of 15 patients of primary closed angle glaucoma(PCAG),which were composed of 11 eyes of 11 patients of acute closed angle glaucoma and 5 eyes of 4 patients of chronic closed angle glaucoma.According to Feng Jian Cheng Tai's operation method, we made two layers scleral flap and cut off the deep one,cut off the out wall of schlemm′s canal, plant one 6~8 mm nylon thread(6 0) in every fracture of tube,went on penetrating trabecular and cut off corresponding irris,suture superficial scleral flap. The postoperative observation included intraocular pressure(IOP), anterior chamber's forming,intraocular reaction, vision, postoperative complication and bleb,etc.The follow up period was 3~10 months(average 6.95months±2.73 months).Results The mean preoperative IOP was (30.25±16 33) mmHg(1kPa=7.5mmHg). The mean postoperative IOPs were (18.01±5.44)? (16.92±5.24)?(16 33±0.65)mmHg,3?6 and 9 months. Difference of IOP between the two groups was statistically significant ( t =2 740?3 024?3.399; P = 0 013?0.007?0.004). The mean preoperative medicine was (2.50±1.33) kinds.During the follow up time, the IOPs of 14 eyes were≤21mmHg(87 5%).8 eyes (40%) had a little postoperative hyphemas and disappeared after 3~5 days .Two eyes had visible seeping and disappeared after 5 days . Two eyes formed bleb .No choroidal detachment and continual hypotomy had occured.Conclusion A combined surgery of schlemm's canal suture implantation and trabeculectomy can effectively reduce IOP and have little postoperative complication and have wide indication .It is possible a kind of new operation of good prospect.