氰基丙烯酸酯组织黏合剂在青光眼滤过泡修复手术中的应用  

Use of cyanoacrylate tissue adhesive in surgical repair of filtering bleb in glaucoma

作　　者：谭艺兰[1] 毛真[2] 钟毅敏[1] 李媚[1] 肖辉[1] 曹丹[1] 刘杏[1] 

机构地区：[1]湖南省儿童医院眼科,长沙410007 [2]中山大学中山眼科中心眼科学国家重点实验室

出　　处：《中华生物医学工程杂志》2010年第5期480-483,共4页Chinese Journal of Biomedical Engineering

基　　金：广东省卫生厅医学科学技术研究基金（B2009083）

摘　　要：目的 探讨氰基丙烯酸酯组织黏合剂在青光眼滤过泡修复手术中应用的有效性和安全性.方法 收集2007年1月至2009年12月就诊于中山大学中山眼科中心的青光眼滤过手术术后的患者10例（10眼）,其中7例行滤过泡部分切除术,氰基丙烯酸酯组织黏合剂替代缝线黏固于角巩膜缘切口处 3例行滤过泡修补术,氰基丙烯酸酯组织黏合剂直接黏附于渗漏处,未予缝线缝合.术后随访6～18个月,观察患者的视力、眼压、前房深度变化、氰基丙烯酸酯组织黏合剂状况,伤口有无渗漏及炎症情况.结果 术前1眼眼压低于6 mm Hg（1 mm Hg=0.133 kPa）,患者平均眼压为（11.2±4.1）mm Hg 术后1个月患者眼压均在8mmHg以上,平均眼压（11.6±2.8）mmHg 随访终点平均眼压（11.5±3.5）mmHg,与术前比较差异无统计学意义（P＞0.05）.使用氰基丙烯酸酯组织黏合剂黏合切口后滤过泡均无渗漏,黏合剂在术后7～20d自动脱落,切口完全愈合,滤过泡无瘢痕化,前房未见炎性反应.悬垂滤过泡患者术前、术后前房深度无明显变化,2例因滤过泡渗漏前房浅的患者术后前房显著加深.结论 滤过泡部分切除术及滤过泡修补术中使用氰基丙烯酸酯组织黏合剂替代缝线缝合,是一种安全有效的方法.Objective To evaluate the safety and efficacy of cyanoacrylate tissue adhesive in surgical repair of filtering bleb in glaucoma. Methods A study was conducted in 10 patients （10 eyes）diagnosed at the Zhongshan Ophthalmic Center, Sun Yat- sen University, between January 2007 and December 2009. Seven out of the 10 patients underwent partial resection of filtering blebs with the corneoscleral incision sealed by cyanoacrylate tissue adhesive instead of sutures, while the remaining 3 patients underwent surgical repair of filtering bleb for glaucoma in which the leakage was directly treated with cyanoacrylate tissue adhesive without suture. The vision acuity, intraocular pressure, anterior chamber depth, status of cyanoacrylate tissue adhesive, wound leakage or inflammation were observed during the follow-up for 6 to 18 months. Results In the 10 patients, the single-eye intraocular pressure was less than 6 mm Hg （1 mm Hg=0.133 kPa） and the mean intraocular pressure was （11.2±4.1 ） mm Hg before surgery,compared with over 8 mm Hg for single-eye intraocular pressure and （11.6±2.8） mm Hg for mean intraocular pressure at one month after surgery. At the end of postoperative follow-up, a mean intraocular pressure （ 11.5±3.5） mm Hg was recorded, with no significant difference as compared with the preoperative data （P〉0.05）.The cyanoacrylate-sealed wounds were free of leakage after surgery. On day 7 to 20 when the cyanoacrylate adhesive normally fell off, the wounds were fully healed, the filtering blebs were found scarless, and there was no inflammatory reactions in the anterior chamber. Among patients with overhanging bleb, the depth of anterior chamber was not significantly changed after surgery, except for 2 patients in whom the anterior chamber was deepened compared to the shallow one previously due to filtering bleb leakage. Conclusion Cyanoacrylate tissue adhesive may be a safe and effective alternative for sutures in partial resection and repair of filtering blebs.

关 键 词：氰基丙烯酸酯 组织黏合剂 青光眼 滤过外科手术 治疗结果 

分 类 号：R779.6[医药卫生—眼科]