非穿透性小梁手术联合透明质酸植入物治疗开角型青光眼  

The clinical effect of non-penetrating trabecular surgery with reticulated sodium hyaluronate implant for treatment of primary open-angle glaucoma

作　　者：叶天才[1] 张秀兰[1] 余敏斌[1] 葛坚[1] 纪晓霞[2] 陈秀琦[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 [2]黑龙江省鹤岗市矿务局总医院眼科

出　　处：《中华眼科杂志》2001年第4期273-277,T005,共6页Chinese Journal of Ophthalmology

摘　　要：目的　探讨非穿透性小梁手术 (non penetratingtrabecularsurgery ,NPTS)联合网状透明质酸植入物的临床疗效。方法　对 2 5例 (2 7只眼 )原发性开角型青光眼 (primaryopenangleglaucoma,POAG)患者进行NPTS联合透明质酸植入物治疗。术后观察眼压、眼内组织反应情况、滤过泡形态 ,并对手术区域进行超声生物显微镜 (ultrasoundbiomicroscopy,UBM)和前房角镜检查。随访时间 3 0～ 10 4个月 ,平均 (6 6 1± 2 47)个月。结果　患者术前眼压平均 (2 6 36± 9 0 2 )mmHg(1mmHg=0 133kPa) ,术后 3个月眼压平均 (14 18± 3 5 1)mmHg ,差异有显著性 (t =6 875 ,P <0 0 5 )。术后无需药物治疗而眼压≤ 2 1mmHg者占 5 6 0 % ,需局部应用药物治疗或术区行残存小梁网激光穿刺治疗眼压≤ 2 1mmHg者占 44 0 %。术前局部应用降眼压药平均 (2 96± 1 43)种 ,术后减至 (0 77± 1 0 7)种 ,差异有显著性 (t=4 716 ,P <0 0 5 )。所有患者术前、后视力差异均无显著性 (χ2 =0 33,P =0 5 6 4)。 2 7只眼中 ,6只眼术后眼压≥ 2 1mmHg ,4只眼有轻微前房出血 ;无前房变浅、炎症、脉络膜脱离等并发症发生。UBM检查结果显示所有患眼在巩膜瓣下均形成一内含植入物的透明液性间腔 ,透明质酸植入物在术后 3个月开始降解 。Objective To evaluate the clinical effect of non penetrating trabecular surgery (NPTS) with reticulated sodium hyaluronate implant in primary open angle glaucoma (POAG). Methods NPTS with reticulated sodium hyaluronate implant was performed on 27 eyes of 25 patients with POAG. The procedure consisted of excising a deep scleral tissue including the external wall of the Schlemm′s canal under a scleral flap without opening the anterior chamber, as the inner wall of the canal was left in place. Then placing a 3 0 mm ×4 5 mm ×0 5 mm or 3 5 mm×3 5 mm×3 5 mm reticulated sodium hyaluronate implant was placed under the flap, so that the aqueous humor may filter through the thin layer of trabeculocorneal membrane spontaneously without forming a flat chamber. The postoperative intraocular pressure (IOP), inflammation and filtering bleb were analyzed. All of patients undertook ultrasound biomicroscopy (UBM) and gonioscopy to evaluate the surgical site on the postoperative 2 weeks, 3, 6 and 9 months. The mean follow up was (6 61±2 47) months. Results The IOP decreased from a mean preoperative value of (26 36±9 02) mm Hg (1 mm Hg=0 133 kPa) to a mean postoperative value of (14 18±3 51) mm Hg ( t =6 875, P <0 05). The number of anti glaucomatous medications, topical or systemical, was reduced from (2 96±1 43) sorts preoperatively to (0 77±1 07) sorts postoperatively. The visual acuity remained stable (no statistical difference with χ 2 test). Six eyes had elevated IOP after operation and were controlled by eyedrops or trabecular puncture with ND:YAG laser. A slight hyphema occurred in 4 eyes with small puncture during operation. The complications such as flat chamber, inflammation and choroidal detachment were not observed. The UBM showed that the sodium hyaluronate implant degraded and a transparent liquid space existed under the scleral flap in all of patients at postoperative 3 months. The gonioscopy showed that at the surgical site the thinner and semitransparent trabecular membr

关 键 词：开角型青光眼 非穿透性小梁手术 青光眼引流植入术 透明质酸 

分 类 号：R779.6[医药卫生—眼科]