非穿透性小梁手术联合透明质酸钠生物胶植入术的临床疗效观察  

Nonperforating trabecular surgery with reticulated hyaluronic acid implant

作　　者：李美玉[1] 

机构地区：[1]北京大学第一医院眼科,100034

出　　处：《中华眼科杂志》2001年第6期404-408,T002,共6页Chinese Journal of Ophthalmology

摘　　要：目的　观察非穿透性小梁手术 (nonperforatingtrabecularsurgery ,NPTS)联合透明质酸钠生物胶植入术的临床疗效。方法　对 2 0例 (2 8只眼 )中、晚期开角型青光眼患者行NPTS联合透明质酸钠生物胶植入术。术后观察眼压、眼内反应和滤过泡 ,并做前房角镜及超声生物显微镜检查。结果术后随访 4 5～ 18 0个月 ,平均 (9 2± 3 4 )个月。术前平均眼压 (2 8 1± 10 2 )mmHg(1mmHg =0 133kPa) ,术后 (17 5± 4 1)mmHg ;差异有非常显著性 (t=5 776 ,P <0 0 0 1)。术前平均用药 (2 0 4± 0 74)种 ,术后 (0 71± 0 71)种 ,差异有非常显著性 (t=8 10 3,P <0 0 0 1)。随访期间眼压≤ 2 1mmHg者 2 7只眼 (96 4 %) ,其中 12只眼 (4 2 8%)不用抗青光眼药物 ,15只眼 (5 3 6 %)加用抗青光眼药物。眼压下降≥ 10mmHg者 13只眼 (4 6 4 %) ,其中不加药者 6只眼。术后 14只眼无任何眼内反应 ;10只眼有轻微房水闪光 ,2～ 6d消失 ;4只眼有少量前房积血 ,3～ 7d消失。术后 2 8只眼均形成显著弥散滤过泡 ;随访期间 ,19只眼有功能性滤过泡 ;9只眼于术后 1 5～ 3 0个月功能性滤过泡消失。 5只眼于术中发现小梁网处有小穿孔 ,但无虹膜膨出 ,术后经前房角镜检查可见 3只眼有小穿孔 ;另 4只眼术中未见小穿孔 ,但前房角镜下?Objective To evaluate the clinical results of nonperforating trabecular surgery (NPTS) with reticulated hyaluronic acid implant. Methods Twenty cases (28 eyes) of advanced open angle glaucoma (C/D=0.86±0.14) underwent NPTS with reticulated hyaluronic acid implant. Postoperatively, the intraocular pressure (IOP), intraocular reactions and the bleb appearance were recorded, gonioscopy and ultrasound biomicroscopy were performed. Results The mean follow-up was (9.2±3.4) months. The mean IOP was (28.1±10.2) mm Hg preoperatively and (17.5±4.1) mm Hg postoperatively, the difference being signifcant (t=5.776, P <0.001). The number of drugs used for anti-glaucoma was (2.04±0.74) preoperatively, and (0.71±0.71) postoperatively (t=8.103, P<0.001). On the last visit, in 27 eyes (96.4%) the IOP was ≤21 mm Hg, and among them, there were 12 eyes (42.8%) without anti-glaucoma medicine and 15 eyes with anti-glaucoma medicine. In 13 eyes (46.4%) the IOP was decreased ≥10 mm Hg in which 6 eyes did not take any anti-glaucoma medicine and 7 eyes used anti-glaucoma medicine. There were no flare and cells in the anterior chamber in 14 eyes. In 10 eyes there was only slight flare that disappeared in 2-6 days. In 4 eyes there was a small amount of hyphema that was absorbed in 3-7 days. After operation, there was an obvious diffuse bleb in each eye, at the last visit, there were functional blebs in 19 eyes, the successful filtration was ceased in 9 eyes within 1.5-3 months. Intra-operatively, in 5 eyes microperforations occurred in the trabecular meshwork without iris prolapes, and after operation, under the gonioscope, the perforation could be observed in 3 eyes. In another 4 eyes, there was no intra-operative perforation, but a small fissure was seen by gonioscopy. In the post-operative 1-8 months, ultrasound biomicroscopy was performed, and it was shown that the implant was not degraded. Conclusions The elevated IOP in patients with open angle glaucoma can be effectively reduced by NPTS, and the number of drugs used for

关 键 词：开角型青光眼 非穿透性小梁手术 透明质酸钠生物胶 NPTS 

分 类 号：R779.6[医药卫生—眼科]