巩膜层间隧道房水引流术治疗难治性青光眼  

Trabeculectomy with scleral tunnel treating refractory glaucoma

作　　者：盘如刚[1] 陈晓明[1] 李茅[1] 刘东敬[1] 

机构地区：[1]四川大学华西医院眼科中心,成都610041

出　　处：《眼科》2006年第2期105-107,共3页Ophthalmology in China

摘　　要：目的探讨巩膜层间隧道房水引流术治疗难治性青光眼的临床效果。设计前瞻性随机对照临床研究。研究对象 87例(98眼)难治性青光眼患者。方法将不同类型难治性青光眼患者随机分为2组,隧道组(50眼)行巩膜层间隧道房水引流术,在浅层巩膜下纵形切除5．0mm×1.5mm条状饭层巩膜和常规的小梁切除,条状巩膜远端超过巩膜床1．5-2．0mm,对照组(48 眼)行常规的小梁切除术。术后随访6-12个月。主要指标视力、眼压、滤过泡、术巾及术后并发症。结果 (1)术后视力隧道组和对照组比较差异无统计学意义(x2=1．15,P=0．76)。(2)术后1周两组眼压与术前相比差异有统计学意义,而组间比较差异无统计学意义(t=1.85,P=0．08);术后6个月隧道组平均眼压(14．34±3．95)mmHg.对照组(19．57±7．76)mmHg;手术成功率:隧道组 88．00％,对照组64．58％,差异均有统计学意义(P<0．05)。(3)隧道组功能性滤过泡82,0％,对照组60．4％,两组比较差异有统计学意义(x2=5．59,P=0．02)。(4)术后隧道组出现浅前房较对照组多,治疗后1周内恢复正常,没有其他并发症。结论对于难治性青光眼,与常规小梁切除术比较,巩膜层间隧道房水引流术在防止滤过道瘢痕形成,术后眼压控制等方面均有明显优势。Objective To investigate the clinical effect of trabeculeetomy with scleral tunnel in the treatment of refractory glaucoma. Design Prospective, randomized and comparative clinical study. Participants 87 patients （98 eyes） with refractory glaucoma. Methods The patients were randomly assigned to reeeiving trabeculectomy with or without scleral tunnel. The tunnel group （50 eyes） underwent trabeculectomy with an additional deep scleral tunnel of 5.0mm×1.5mm beneath the superficial scleral flap. The control group （48 eyes ） underwent conventional trabeculeetomy. The average follow-up period was 6 to 12 months postoperatively. Main Outcome Measures Visual acuity, intraocular pressures （IOP）, filtering blebs, operative and postoperative complications. Results （ 1 ） No significant differences in visual acuity were found between two groups. （2） The postoperative IOPs were significantly lower than the preoperative IOPs in both groups, while the IOPs on the 7th day after the surgery between the two groups were not different significantly. The average postoperative IOP at the 6th month in the tunnel group was 14.34±3.95 mmHg and 19.57±7.76 mmHg in the control group, which were different significantly （P〈0.05）. The successful rates were 88.00% and 64.58% in two groups respectively. （3） The percentage of functional filtering blebs in the tunnel group was 82.0%, significantly higher than that of 60.4% in the control group （P〈0.05）. （4） The incidence rate of shallow anterior chamber in the tunnel group was higher than that in the control group, but all the cases had recovered by the end of 1 week after proper treatment. There were no relative complications. Conclusion The trabeculectomy with scleral tunnel has the advantages of preventing postoperative scar formation and achieving better control of postoperative IOP over the conventional trabeculectomy in treating refractory glaucoma.

关 键 词：青光眼/外科学 巩膜层间隧道房水引流术 

分 类 号：R779.6[医药卫生—眼科]