非穿透性小梁切除加羊膜移植治疗开角型青光眼

Nonperforating trabecular surgery with amniotic membrane transplantation in treatment of open-angle glaucoma

目的观察非穿透性小梁手术(nonperforating trabecular surgery,NPTS)联合羊膜移植的治疗效果。方法对106例136眼开角型青光眼患者行NPTS联合羊膜植片瓣下植入术,术后观察视力、眼压、眼内反应、滤过泡及并发症,并做前房角镜检查。结果术后眼压控制成功率为97.1％,不需辅用降眼压药物;术后眼压≥21mmHg者2.9％,应用降眼压药物眼压控制正常,眼压控制总有效率100％。功能性滤过泡69.4％,无滤过泡但眼压正常者17.7％;无滤过泡应用降眼压药物眼压控制正常者2.9％。术后视力提高1—2行。4眼发生前房少量出血,在48～72h内吸收;23眼前房内有轻度闪光,2～4d消失;无浅前房、角膜水肿、脉络膜脱离等并发症的发生。结论 NPTS能建立良好的多途径的房水引流,达到降眼压的目的;羊膜可有效地防止滤过泡的瘢痕组织形成,使滤过区滤过通畅,并能有效的长期保留功能性滤过泡;NPTS联合羊膜植片瓣下植入术提高了眼压控制成功率,是一种安全有效的新的抗青光眼手术方法。

Aim To observe the therapeutic effect of nonperforating trabecular surgery (NPTS) combined with amniotic membrane transplantation. Methods For 106 cases (136 eyes) of open-angle glaucoma, NPTS was performed together with amniotic membrane implantation. Postoperatively, vision, intraocular pressure (IOP), intraocular reaction, filtering bleb and complications were observed. Gonioscopy was conducted. Results In 97.1% patients, postoperative IOP was controlled successfully and for them, drugs to reduce IOP were unnecessary; in 2.9% patients, IOP was≥21mmHg and for them, drugs were given to achieve normal IOP. Thus, the total success rate of IOP control was 100%. In 69.4% patients, functional filtering blebs were formed. In 17.7% patients, there were no filtering blebs but IOP was normal. In 2.9% patients, IOP was brought to normal with drugs in the absence of filtering blebs. Postoperative vision improved by 1-2 lines. Scarce bleeding inside anterior chamber occurred in 4 eyes, which was absorbed within 48-74h. In 23 eyes, there was slight flash in anterior chamber, which disappeared within 2-4d. No shallow anterior chamber, corneal edema, choroidal detachment occurred. Conclusion NPTS can establish multi-approach aqueous drainage so as to reduce IOP. Use of amniotic membrane prevents scarring of filtering blebs so as to keep the filtering area free and to maintain the function of filtering blebs for long time. NPTD combined with amniotic membrane transplantation increases the success rate of IOP control and is a safe and effective anti-glacomatous procedure.