非穿透性小梁手术后的超声生物显微镜检查

Ultrasound biomicroscopy on eyes after NPDS

目的 :通过原发性开角性青光眼 (POAG)的非穿透性小梁手术 (NPTS)术后的超声生物显微镜 (UBM )检查 ,了解手术部位的形态、结构的变化及其和临床疗效的关系。有助于进一步提高手术成功率。方法 :对 2 0 0 0年 2月～ 2 0 0 2年 3月收治我院的 2 3例药物不能控制的POAG进行NPTS ,其中 12例同时联合羊膜植入。男性 17例 ,女性 6例。平均年龄 5 3 0 4± 15 16岁 (2 0～ 71岁 )。右眼 13例 ,左眼 10例。术前平均眼压 2 6 2 6± 6 66mmHg ,平均运用降眼压药物 2 48± 0 5 1种。平均随访期 9 78± 7 79月 (1～ 2 6月 )。在不同的随访期对手术部位进行UBM检直 ,包括滤泡形态、巩膜内房水池、房角、残留的小梁 -后弹力层厚度。结果 :术后各期平均眼压均低于术前平均眼压 ,差异有显著性。术前平均眼压 2 6 2 6± 6 66mmHg术后 6个月、 9个月、 12个月、 18个月平均眼压分别为 16 89± 4 19mmHg、 19 14± 5 95mmHg、 18 5 0± 4 3 6mmHg、 18 79± 3 5 8mmHg。术前平均运用降压药物 2 48± 0 5 1种 ,术后 6个月、 12个月平均用药数分别为 0 67± 0 98种、 1 10± 0 88种。手术部位UBM检查结果 :本组 2 3眼在随访期末高回声型滤泡占 3 0 4% (7/2 3 ) ,低回声型占 43 5 % (10 /2 3 ) ,囊型占 17 4%

Objective:To study the appearance,structure of the sclerectomy site and clinical effects through ultrasound biomicroscopy (UBM) in eyes with POAG underwent NPDS. Methods:23 eyes of 23 patients with medically uncontrolled primary open angle glaucoma underwent NPTS,eleven eyes with human amniotic membrane implantation.Ultrasound of the sclerectomy site was performed at different following up periods after surgery.The following factors were observed,conjunctival bleb appearance, condition of suprascleral aqueous lake,state of angle,and the thickness of residual trabeculocorneal membrane. Results:Through ultrasound biomicroscopy on the sclerectomy site,hyperechoic bleb in 7 eyes (31.82%),hypoechoic bleb in 10 eyes (45.45%),cyst bleb in 4 eyes (18.18%) and flat bleb in 2 eye (8.70%).Suprascleral aqueous lakes in different size and trabeculocorneal membranes in different thickness (71～248um) were observed in 20 eyes.NPDS with or without human amniotic membrane implantation did not influence the size of suprascleral aqueous lake.In one case,a hypoechoic area in the suprachoroidal space was observed and the IOP maintained 10 mmHg continuously. Conclusions:Under UBM,conjunctival bleb after NPDS was showed in hyperechoic (31.82%),hypoechoic (45.45%),cyst (18.18%) and flat (4.55%) appearances.NPDS with or without human amniotic membrane implantation did not influence the size of suprascleral aqueous lake.