两种小梁手术构建评价及降眼压临床研究

COMPARISON BETWEEN NONPERFORATING TRABECULAR SURGERY AND TRABECULECTOMY IN PRIMARY OPEN-ANGLE GLAUCOMA

目的 :比较非穿透小梁手术与小梁切除术术后早期的降眼压效果及两种手术术中和术后早期的并发症的发生情况。方法 :共观察 5 1例中晚期原发性开角型青光眼患者 (6 9只眼 ) ,其中 2 8例 (36只眼 )为在我科开展非穿透性小梁手术前接受小梁切除术的患者 ,另 2 3例 (33只眼 )为接受非穿透性小梁手术的患者 ,均为连续病例。比较两组间年龄、术前眼压、术前用药种类、术前视力及术前术后眼压、视力的变化幅度 ,两组术中及术后各种并发症的发生情况。结果 :两组间年龄、术前眼压、术前用药种类、术前视力经统计学检验差异均无显著性 ,小梁切除组术后平均眼压为 12 .89± 4 .0 6mmHg ,NPTS组术后平均眼压为 12 .91± 3.87mmHg ,两组的术前术后眼压自身比较差异均有极显著性 (t=7.5 5 6 ,5 .86 7,均P <0 .0 0 1)。术前术后眼压下降的幅度两组间差异无显著性 (Z =- 1.395 ,P >0 .0 5 )。小粱切除术组有 2只眼术中有较多量前房出血。非穿透小梁手术组有 3只眼术中发现小梁网处有小的穿孔 ,但无虹膜膨出。小梁切除组的术后视力下降幅度大于非穿透小梁手术组 ,差异有显著性 (Z =- 2 .797,P <0 .0 5 )。小梁切除术组出现滤过泡渗漏的较非穿透小梁手术组多 ,两组间差异有显著性 (P =0 .0 14 )。小梁切除组有

Objective:To establish the efficacy and safety in the early stage post-operation of nonperforating trabccular surgery versus trabeculectomy in primary open-angle glaucoma.Methods:A total of 51 patients (69 eyes) with primary open angle glaucoma were included in the study. 28 patients (36 eyes) received trabeculectomy (group 1) and 23 patients (36 eyes) received NPTS with reticulated hyaluronic acid implant (group 2) . Intraocular pressure (IOP) and visual acuity measured pre and 2 weeks post operation and complications in the early stage postoperation were compared between two groups. Results:Post operative mean IOP was 12.89±4. 06mmHg in group 1 and 12.91±3.87mmHg in group 2. Statistically significant differences between pre-operative and postoperative IOP were found in both groups. ( t =7.556, 5.867, both P <0.001)? And the extent of the IOP reduction from pre-operative to postoperative was similar between two groups. (Z=-1. 395, P >0.05)? Hyphema was found in 2 eyes during surgery exclusively in group 1 and small perforation of trabecular meshwork without iris prolapse was encountered in 3 eyes in group 2. The reduction of visual acuity frompre-operative to postoperative were more evident in group i than group 2, (Z=-2.797, P <0. 05 )? Wound leakage was encountered in 9 eyes in group 1 and only in 1 eye in group 2 and was found to be statistically different in two groups. ( P =0.014) . Flat/shallow anterior chamber was found in 11 and 3 eyes respectively in group 1 and 2. Hyphema was found in 4 and 1 eyes respectively in group 1 and 2. Ciliary body or choroidal detachment was encountered in 3 eyes exclusively in group 1. Conclusions: NPTS with reticulated hyaluronic acid implant may provide comparabie tOP reduction in the early stage of postoperation with fewer complications in management of primary open angle glaucoma.