羊膜移植在复合式小梁切除术治疗难治性青光眼的临床研究  

Clinical Research of Amniotic Membrane Transplantation in Complex Trabeculectomy for the Treatment of Refractory Glaucoma

作　　者：刘鹤南[1] 聂庆珠[1] 陈晓隆[1] 朱颖[2] 李迅[1] 陆岩[1] 高殿文[1] 

机构地区：[1]中国医科大学附属盛京医院眼科,沈阳110004 [2]中国医科大学附属第一医院神经内科,沈阳110001

出　　处：《中国医科大学学报》2009年第8期615-617,共3页Journal of China Medical University

基　　金：辽宁省教育厅科研基金资助项目(202013128)

摘　　要：目的评价羊膜移植(AMT)在复合式小梁切除术中治疗难治性青光眼的临床疗效。方法采用前瞻性随机对照临床试验研究,对35例(35眼)具有高危因素如新生血管、葡萄膜炎、无晶状体、人工晶状体和发育性的难治性青光眼,AMT组18例行复合式小梁切除术联合巩膜瓣下单层AMT,对照组17例行复合式小梁切除术。术后观察、比较的指标包括:术后眼内压(IOP)、抗青光眼药物使用数量、滤过泡形态特点以及术后并发症。所有研究对象随访12个月。结果术后6个月,手术完全成功(IOP在6～21 mmHg之间,并且不需加用任何抗青光眼药物):AMT组93.75%,对照组56.25%(P=0.019);术后12个月,手术完全成功:AMT组81.25%,对照组43.75%(P=0.033)。术后12个月,AMT组和对照组IOP分别从术前(49.9±11.5)mmHg、(48.8±11.2)mmHg降至(15.7±1.1)mmHg、(19.8±2.3)mmHg(P<0.01)。对照组术后早期出现低眼压3例(17.65%),AMT组未发生(P=0.095);对照组出现包裹性滤过泡6例(35.29%),AMT组仅出现1例(5.56%)(P=0.037)。结论复合式小梁切除术联合AMT治疗难治性青光眼,具有手术成功率高,术后IOP控制良好,术后并发症发生率低的特点。Objective To investigate clinical outcomes of refractory glaucoma patients treated with the complex trabeculectomy and amniotic membrane transplantation（AMT）.Methods Thirty-five patients with refractory glaucoma were involved in this prospective and random trial at such high risks as neovascular,uveitis,aphakia,pseudophakic,and young ages.Complex trabeculectomy with single-layer AMT under the scleral flap was performed in 18 eyes and complex trabeculectomy without AMT in 17 eyes.The outcome′s evaluation included postoperative intraocular pressure （IOP） ,number of antiglaucoma medications ,the raorphologic characteristics of the filtering blebs and complications. All patients were followed up for 12 months. Results The postoperative complete success rate （IOP between 6-22 mmHg without glaucoma medications） was 93.75% in AMT group and 56.25% in control group at 6 months （P = 0.019）,81.25% and 43.75% at 12 months after surgery respectively （P = 0.033 ）. IOP was decreased from （49.9±11.5 ）mmHg and （48.8±11.2）mmHg preoperatively in study and control groups to （15.7±1.1）mmHg and （19.8±2.3）nunHg at 12 months respectively （P 〈 0.01 ）. Early postoperative hypotony occurred in 3 （17.7%） control eyes but none of study eyes （P = 0.095）. Encapsulated bleb was observed in 6 （35.29%） control eyes but in 1 （5.56%） study eye （P = 0.037 ）. Conclusion The combination of complex trabeculectomy and AMT might improve the clinical outcome of the patients with refractory glaucoma such as higher success rates, lower postoperative mean IOPs, and less complication rates.

关 键 词：羊膜移植 复合式小梁切除术 难治性青光眼 

分 类 号：R775[医药卫生—眼科]