非穿透小梁手术治疗原发性开角型青光眼的远期疗效  

The long term curative effect of the nonpenetrating trabecular surgery.

作　　者：黄燕[1] 王宁利[2] 王班伟[1] 黎立军[1] 

机构地区：[1]广东医学院第二附属医院眼科,湛江524003 [2]首都医科大学附属北京同仁医院眼科中心

出　　处：《眼科》2006年第4期277-280,共4页Ophthalmology in China

摘　　要：目的评价非穿透小梁手术治疗原发性开角型青光眼（POAG）的远期疗效与失败原因。设计随机化临床试验。研究对象POAG患者105例（111眼）。方法对55眼和56眼分别非穿透小梁手术和复合式小梁切除术，术后随访30～48个月。主要指标视力、眼压、滤过泡、前房角、并发症．结果术后48个月非穿透小梁手术组视力优于复合式小梁切除组（F=7．7381，P〈0．05）．在6、12、24、36、48个门时非穿透小梁手术组和复合小梁切除组手术成功率分别为91％、77％、70％、67％、60％和91％、86％、82％、81％、78％。6、12、24、36个月两组间比较无显著性差异（X^2=0．08、0．748、2．93、3．53；P〉0．05），但48个月时非穿透小梁手术组手术成功率硅著低丁复合小梁组（X^2=5．26，p〈0．05）。非穿透小梁手术组48个月时功能性滤过泡保存仪占47％，少于复合小梁切除组（76％），非穿透小梁手术组术区滤过膜发生纤维化增厚30例（54．5％），虹膜周边前粘连12例（21．8％）？结论非穿透小梁手术组术后6个月前与复合式小梁切除术手术成功率相当，而远期则低于复合式小梁切除术。术后眼压升高，除滤过泡瘢痕化因素外与手术区滤过膜的纤维化增厚及虹膜周边前粘连导致房水滤过减少密切相关。（眼科，2006，15：277—280）Objective To evaluate the long term curative effectiveness and the failure cause of the nonpenetrating trabecular surgery （NPTS） for primary open angle glaucoma （POAG） . Design Randomized clinical trial. Participants 105 patients （111 eyes） with POAG. Methods 52 patients （55 eyes） and 53 patients （56 eyes） underwent NPTS and trabeculectomy respectively. The follow-up period was 30 to 48 nlonths （mean, 40.1＋8.2 months ）. Main Outcome Measures Visual acuity, intraoeular pressure（IOP）, filtering blebs, alteration of anterior chamber angle and complications. Results Visual acuity in the NPTS group was significantly superior to that in the trabeeulectomy group （X^2=7.7381,P〈0.05） .The successful rate at 6,12,24,36,48 months after operation was 91%, 77%, 70%, 67%, 60% in the NPTS group and 90%, 86%, 82%, 81%, 78% in the trabeealectomy group .There was no significant difference between the two groups at 6, 12, 24, 36 months after operation X^2=0.08, 0.748, 2.93, 3.53; P〉0.05, respectively）. But the successful rate in the NPTS group 48 months after operation was significantly lower than that in the trabecalectomy group （X^2=5.26,P〈 0.05）. Only 47% of functional filtering blebs were preserved in NPTS group 48 months after operation, which was lower than that in the trabecalectomy group （76%）. The filtration membrane at the operation area of 30 cases （54.5%） in the NPTS group was fibrously thickened and peripheral anterior synechia was found in 12 cases （21.8%）. Conclusions The success rate of the NPTS is equal to trabeculectomy in short or intermediate term. But it is lower in long term of 48 months. The increase of lOP after the NPTS is related to the fibrous thickening of the filtration membrane in the operation area and the peripheral anterior synechia. （Ophthalmol CHN, 2006, 15：277-280 ）

关 键 词：原发性开角型光眼/外科学 非穿透小梁手术 

分 类 号：R779.6[医药卫生—眼科]