小梁切除术联合可拆除缝线治疗原发性闭角型青光眼的随机对照临床试验:18个月效果  

The efficacy of releasable suture in trabeculectomy among patients with primary angle-closure glaucoma: a 18-month randomized controlled study

作　　者：梁远波[1,2] 孟海林[3] 范素洁[4] 王星 谢丽莲 冯梅艳[1,7] 王瑞[3] 常新琦 何颜清 马锦霞[3] 罗颖[3] 崔宏宇[4] 贾超 张祎草[3] 刘洛如 唐炘[1] 王宁利[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科与视觉科学重点实验室,100730 [2]香港中文大学眼科与视觉科学学系 [3]河南省安阳市眼科医院 [4]河北省邯郸市眼科医院 [5]辽宁省抚顺市眼病医院 [6]湖南省郴州第一人民医院眼视光中心 [7]山东省枣庄市立医院眼科

出　　处：《眼科》2013年第1期19-24,共6页Ophthalmology in China

摘　　要：目的比较小梁切除术联合可拆除缝线和单纯小梁切除术对原发性慢性闭角型青光眼患者18个月的眼压控制效果。设计多中心随机对照临床试验。研究对象来自4个眼科中心40岁以上原发性闭角型青光眼患者175例(175眼)。方法随机分为小梁切除术联合可拆除缝线组(88眼)和单纯小梁切除术组(87眼)。术后1天、7天、2周、4周、3个月、6个月、12个月、18个月随访。LogMAR视力表检查视力,Goldmann压平眼压计测量眼压。眼压控制成功指在末次随访时未使用降眼压药物眼压<21 mm Hg;条件成功指在末次随访时在联合使用降眼压药物情况下眼压<21 mm Hg。主要指标眼压,眼压控制成功率,并发症。结果 150例(85.7%)完成18个月随访,其中小梁切除术联合可拆除缝线组74例,单纯小梁切除术组76例。术后4周、3个月、6个月、12个月、18个月两组眼压均无明显差异(P均>0.05)。小梁切除术联合可拆除缝线组眼压控制成功率91.9%(68/74),单纯小梁切除术组84.2%(64/76)(P=0.148);条件成功率前者91.9%(68/74),后者88.2%(67/76)(P=0.448)。视力下降两行者小梁切除术联合可拆除缝线组20.3%,单纯小梁切除术组14.5%(P=0.348)。后者暂时性低眼压发生率(19.7%)高于前者(9.6%),而术后浅前房、脉络膜脱离、黄斑水肿、前房出血发生率两组相似。结论小梁切除术联合可拆除缝线对原发性慢性闭角型青光眼患者的18个月成功率略高于单纯小梁切除术,并发症发生率两组相当。联合可拆除缝线技术的小梁切除术更适合于具有术后浅前房风险的患者。Objective To compare the post-operative intraocular pressure （IOP） and incidence of complications following trabeculectomy with releasable suture to standard trabeculectomy in Chinese patients with primary angle-closure glaucoma （PACG）. Design Multi-centered randomized controlled clinical trial. Participants 175 PACG patients （175 eyes） with 6 clock-hours or more of peripheral anterior synechia from 4 eye centers. Methods Patients were randomly allocated to trabeculectomy with releasable suture group （2 permanent and 2 releasable sutures to the scleral flap） （n=88） and single trabeculectomy group （only 2 interrupted permanent sutures） （n=87）. IOP, visual acuity, and complications were recorded during follow-up at post-operative day 1, day 7, 2 weeks, 4 weeks, 3 months, 6 months, 12 months, and 18 months. Absolute success was defined as the post-operative IOP was less than 21 mmHg without any anti-glaucoma medications. Conditional success was defined as the post-operative IOP could be lower than 21mmg with anti-glaucoma medications at the last visit. Main Outcome Measures IOP, success rate, complications. Results 150 subjects （85.7%） attended the 18 months follow up visit, with 74 in releasable suture group and 76 in single trabeculectomy group. There were no significant differences of the IOP between the two group at the visit of week 4, month 3, month 6, month 12 and month 18 （all P〉0.05）. The absolute success rate in releasable suture group was 91.9% （68/74）, and 84.2% （64/76） in standard trabeculectomy group （P=0.148）. The condition success rate was 91.9% （68/74） in releasable suture group while 88.2% （67/76） in single trabeculectomty group （P=0.448）. Presenting visual acuity decreased by 2 lines or more accounted for 20.3% in releasable suture group and 14.5% in single trabeculectomy group （P=0.348）. A transient hypotony occured in 19.7% of the subjects in single trabeculectomy group, higher than that in releasable suture group （9.6%） but n

关 键 词：原发性闭角型青光眼 小梁切除术 可拆除缝线 多中心临床试验 

分 类 号：R779.6[医药卫生—眼科]