一种新的技术——非穿透性小梁手术初步临床报告  

A Prelimiary Report of a New Technique:Non-penetrating Trabecular Surgery

作　　者：张秀兰[1] 叶天才[1] 葛坚[1] 余敏斌[1] 陈秀琦[1] 纪晓霞[1] 冀建平[1] 

机构地区：[1]中山医科大学中山眼科中心,广州510060

出　　处：《眼科学报》1999年第4期242-245,共4页Eye Science

摘　　要：目的:评价非穿透性小梁手术联合透明质酸钠生物胶植入在原发性开角型青光眼(primaryopen angle glaucoma,POAG)中的临床疗效和治疗作用。方法:对22例24只眼需手术治疗的POAG患者进行非穿透性小梁手术联合透明质酸钠生物胶植入。手术方法是在不打开前房的情况下,切除与Schlemm管内壁平齐的深层巩膜角膜组织,然后植入3mm×4.5mm×0.5mm或3.5mm×3.5mm×3.5mm的透明质酸钠生物胶膜。术后对其眼压、眼内反应情况、滤过泡形态及手术区局部超声生物显微镜(ultrasound biomicroscopy,UBM)检查结果进行分析。随访时间平均3.9±2.2个月。结果:术前平均眼压24.4±9.1mmHg,术后平均15.1±3.7mmHg,差异有显著性(P<0.01)。术前平均用局部降眼压药2.8±1.4种,术后减为0.7±1.0种,差异亦有统计学意义(P<0.01)。所有患者术前与术后的视力变化不大。6只眼术后眼压升高;2只眼有轻度前房出血;无一例出现前房变浅、炎症、脉络膜脱离等并发症。术后1～3个月UBM结果显示透明质酸钠生物胶尚未降解,所有病例在巩膜瓣下形成一透明液间腔,部分病例在结膜下伴有滤过泡形成。结论:非穿透性小梁手术联合透明质酸钠生物胶植入能有效降低高眼压或减少应用青光眼药的种数,无穿透性小梁切除术的严重并发症,术后护理简单,可在门诊开展此手?Objective: To evaluate the clinical effect of nonpenetrating trabecular surgery with sodium hyaluronate gel implant in Primary Open-Angle Glaucoma ( POAG ). Methods: Twenty-four eyes of 22 patients with medically uncontrolled POAG were underwent nonpenetrating trabecular surgery with hyaluronate gel implant. The procedure was performed involing excising a deep-sclera tissue that flush with innerwall of Schlemm' s canal without opening the anterior chamber, then placing a 3mm × 4. 5mm × 0. 5mm or 3. 5mm × 3. 5mm × 3. 5mm sodium hyaluronate gel implant under the scleral flap respectively. The postoperative Intraocular Pressure (IOP), Inflammation and fitering bleb were analysised. All of patients were undertaken ultrasound biomicroscopy (UBM) to evaluate the surgery site on postoperative 1 -3months. Mean follow-up was 3. 9 +2. 2 months. Results : The IOP decreased from a mean preoperative value of 24. 4 ± 9. 1 mmHg to a mean postoperative value of 15.1 ±3.7 mmHg (P < 0.01). The number of anti-glaucomatous medications by topically or systemically was reduced from preoperative sorts of 2. 8 ± 1. 4 to postoperative sorts of 0. 7 ± 1. 0 ( P < 0. 01) . The visual acuity remained stable, 6 eyes had IOP elevated and 2 eyes had occured hyphema. The complications such as flat chamber, inflammation and detachment of choroid were not observed. The UBM showed that the hyaluronate gel implant wasn' t degraded and a transparent liquid space was formed under the scleral flap in all of patients on postoperatively 1-3 month. The filtering blebs were formed in some patients. Conclusion: Nonpenetrating trabecular surgery with hyaluronate gel implant can effectively lower IOP and reduce the number of anti-glaucomatous medications. No severe complications occured. With a simple postoperative nursing, it can be performed in clinic. It is proved to be a promising and new special technique to treat glaucoma. Eye Science 199; 15: 242 - 245.

关 键 词：青光眼 非穿透性 小梁手术 透明质酸钠 生物胶 

分 类 号：R775.05[医药卫生—眼科] R779.6[医药卫生—临床医学]