非穿透性小梁手术联合透明质酸钠生物胶植入术治疗开角型青光眼  

The clinical observation of nonperforating trabecular surgery with reticulated hyaluronic acid implant for treatment of open-angle glaucoma

作　　者：郭燕[1] 夏晓波[1] 江海波[1] 王平宝[1] 黄佩刚[1] 刘双珍[1] 许雪亮[1] 

机构地区：[1]中南大学湘雅医院眼科,中国湖南省长沙市410008

出　　处：《国际眼科杂志》2006年第1期92-96,共5页International Eye Science

摘　　要：目的:探讨非穿透性小梁手术(nonperforatingtra-becularsurgery,NPTS)联合透明质酸钠生物胶植入术的临床疗效。方法:对34例(48眼)开角型青光眼的患者实施NPTS联合透明质酸钠生物胶植入术。术后观察视力、眼压、滤过泡、前房反应、前房形成情况及并发症。结果:术后随访3～22(平均8.2±4.1)mo。术前平均眼压(34.18±13.30)mmHg(1mmHg=0.133kPa),术后(7.71±2.69)mmHg;差异有显著性t=14.710,P<0.001。术前平均用药(2.77±0.77)种,术后(0.71±1.05)种,差异有显著性t=4.616,P<0.001。随访期间眼压≤21mmHg者46眼(96%),其中27眼(59%)不用抗青光眼药物,19眼(41%)加用抗青光眼药物。术后24眼无任何反应;10眼前房有轻度闪辉,术后2～5d消失;8眼有少量前房积血,积血均于2～4d消失。6眼出现低眼压性黄斑水肿(22%),均于术后随着眼压的回升而消失。术后均无浅前房、睫状体或脉络膜脱离等并发症发生。所有患者术后均形成显著弥散滤过泡。其中42眼I型滤过泡,6眼II型滤过泡。术后6mo复查32眼I型滤过泡,11眼II型滤过泡,1眼III型滤过泡。结论:NPTS联合透明质酸钠生物胶植入术,可有效降低眼压,并减少抗青光眼药物的应用,术后并发症少,术后远期疗效尚可,为一种治疗开角型青光眼的有效方法。AIM： To evaluate the clinical effect of nonperforating trabecular surgery （NPTS） combined with reticulated hyaluronic acid implant on the treatment of open-angle glaucoma. METHODS： NPTS combined with reticulated hyaluronic acid implant was performed on 48 eyes of 34 patients with open-angle glaucoma. Postoperative visual acuity, intraocular pressure （IOP）, bleb appearance, intraocular reactions and complications were observed. RESULTS： The mean follow-up was （8.2＋ 4.14）mo. The mean IOP was （7.71± 2.69）mmHg postoperatively, significantly higher than the IOP preoperatively （34.18±13.30mmHg） （t=-14.710,P 〈0.001）.The number of anti-glaucoma drugs was （2.77±0.77） preoperatively, more than the drugs （0.71±1.05） postoperatively（t=-4.616,P〈0.001）. On the last visit, in 46 eyes （96%） the IOP was ≤21mmHg, among which there were 27 eyes （58.7%） without anti-glaucoma medicine and 19 eyes with anti-glaucoma medicine. There were no flare and cells in the anterior chamber in 24 eyes. In 10 eyes there was only slight flare that disappeared in 2 -5d. In 8 eyes there was a small amount of hyphema that was absorbed in 2 -4d. In 6 eyes there was macular edema with hypotension that was disappeared with the reconstitution of IOP. The complications such as fiat chamber, ciliary body or choroidal detachment were not observed .After the operation, there was an obvious diffuse bleb in all the eyes, and among them., there were 42 eyes with type Ⅰ diffuse bleb and 6 eyes with type II diffuse bleb. At 6mo postoperatively, there were 32 eyes with type Ⅰ diffuse bleb, 11 eyes with type Ⅱ and 1 eye with type Ⅲ diffuse bleb. CONCLUSION： Nonperforating trabecular surgery with reticulated hyaluronic acid implant can effectively lower the IOP and reduce the sorts of anti-glaucoma medications. The post-operative complications were much less because of no intraoperative penetration of the anterior chamber. Therefore, NPTS is a new, simple and effective way for the treatment of

关 键 词：青光眼 开角型 非穿透性小梁手术 透明质酸钠生物胶 

分 类 号：R779.6[医药卫生—眼科]