非穿透性小梁手术联合2种不同植入物治疗原发性开角型青光眼  

Non-penetrating trabecular sur-gery with two kinds of different drainage implants in treatment of patients with primary open-angle glaucoma

作　　者：薛兆武 李军 

机构地区：[1]枣庄矿业集团中心医院眼科,山东省枣庄市277011

出　　处：《眼科新进展》2006年第8期614-616,共3页Recent Advances in Ophthalmology

摘　　要：目的研究非穿透性小梁手术（non—penetrating trabecular surgery，NPTS）联合透明质酸钠凝胶或羊膜植入术治疗原发性开角型青光眼（primary open-angle glaucoma，POAG）的临床效果。方法将42例（84眼）嗍患者随机分为A、B2组，每组21例（42眼）。A组行NFPS＋SKGEL植入。B组行NPTS＋羊膜植入。术后观察患者眼压、眼内反应及滤过泡情况，并做前房角镜检查。患者术后随访6月～2a．平均（14．6±2．3）月。结果2组患者术后视力较术前无明显变化。A组患者术前平均眼压（40．3±8．7）mmHg（1kPa=7．5mmHg），术后（15．7±5．8）mmHg，差异有显著性意义（t=10．872，P〈0．01）；B组患者术前平均眼压（40．8±9．1）mmHg，术后（15．5±5．3）mmHg，差异有显著性意义（t=11．023，P〈0．01）。A、B2组比较，无显著性差异。术后A组有1眼植入物脱出，B组有1眼轻微前房出血；2组均无浅前房、明显的眼内炎性反应及脉络膜脱离等并发症。术后患者经前房角镜检查，可见术区变薄的小梁网-后弹力膜窗，A组2眼、B组1眼可见小梁处微穿孔。结论NPTS联合SKGEL或羊膜植入术均能有效降低眼压，术后并发症少，是治疗POAG的有效方法。相比之下，羊膜取材容易、经济。Objective To evaluate the clinic effect of non-penetrating trabecular surgery （NPTS） with amniotic membrane and SKGEL implants on patients with primary open-angle glaucoma （POAG）. Methods Eighty-four eyes of 42 patients with POAG were divided into two groups（group A and group B）, and each group consisted of 42 eyes of 21 patients. NPTS with SKGEL implant was performed in group A, and with amniotic membrane implant in group B. Intraocular pressure （IOP） were measured pre- and post-operatively by non-contract tonometer, intraocular irritations and the bleb appearances were recorded, and the anterior chamber angle of post-operation was observed by gonioscopy. The postoperative data were analyzed along with 6-24 months follow-up. Results The postoperative vision of two groups patients were unchanged. IOP in group A of post-operation was significantly decreased （ 15.7 ± 5.8） mmHg （ 1 kPa = 7.5 mmHg; t = 10. 872, P 〈 0.01 ）, compared with that of pre-operation （40.3 ± 8.7） mmHg; IOP in group B of post-operation was significantly decreased （15. 5 ± 5.3） mmHg（ t = 11.023,P〈0.01）,compared with that of pre-operation （40.8 ± 9.1 ） mmHg. But no statistical signification（ P 〉 0.05）was found. There was a small amount of hyphema in 1 eye of group B and SKGEL emerged in 1 eye of group A. The gonioscopy showed that the remnant trabecular meshwork and descemet membrane were thinner at the surgical site,and microperforation occurred in the trabecular meshwork in 2 eyes of group A and 1 eye of group B, respectively. Conclusion NPTS with amniotic membrane and SKGEL implant can effectively control the elevated IOP and decrease the complications in the patients with POAG. So it is an effective and new method for the treatment of patients with POAG. Compared with SKGEL, amntottc membrane is easy acquired and cheap.

关 键 词：开角型青光眼 小梁切除术 羊膜 

分 类 号：R775.2[医药卫生—眼科]