小梁消融术疗效和安全性的临床观察  

Preliminary investigation on the safety and efficacy of Trabectome

作　　者：黄萍[1] 王怀洲[2] 吴慧娟[3] 孙嫣然[1] 王旻舒 崔莹[2] 邱伟强[1] 杨一佺 任泽钦[3] 张纯[1] 王宁利[2] 

机构地区：[1]北京大学第三医院眼科视觉损伤与修复教育部重点实验室,100191 [2]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研究所北京市眼科学与视觉科学重点实验室 [3]北京大学人民医院眼科

出　　处：《中华眼科杂志》2015年第2期115-119,共5页Chinese Journal of Ophthalmology

摘　　要：目的 观察小梁消融术治疗开角型青光眼的安全性和有效性.方法 前瞻性非对照病例系列.开角型青光眼患者41例,包括POAG患者34例,发育性青光眼3例,色素性青光眼4例.全面眼科检查后行小梁消融术,其中9例联合超声乳化白内障吸除手术.记录术前和术后的眼压、降眼压药物使用情况及术后并发症等.以术后3个月后随机2次随访眼压均≤21 mmHg（1 mmHg=0.133 kPa）,眼压下降≥20％（用或不用降眼压药物）且无二次手术定义为手术成功.统计分析使用R统计软件进行（R project）.眼压和降眼压眼药数与基线的比较采用Wilcoxon符号秩检验,并采用bonferroni比较法进行校正.使用Kaplan-Meier生存分析方法对结果进行分析.结果 41例患者中随访达到12个月者为21例（51.2％）.术前平均眼压（22.5±8.1）mmHg,术后12个月平均眼压（17.6±6.4） mmHg,术后眼压下降有统计学意义（P=0.02）.术前平均用局部降眼压药（2.0±0.9）种,术后12个平均用局部降眼压药（1.2±0.9）种.术后使用局部降眼压药物数量减少有统计学意义（P=0.02）.手术中消融小梁网时均出现不同程度的一过性回血,术中无其他并发症的出现.1年成功率为85％,4例需要行二次手术.结论 小梁消融术创伤小,手术时间短,手术后护理简单,术中及术后并发症少,降压效果明确,但仍需大样本、长期随访进一步验证.Objective To evaluate the safety and efficacy of ab interno trabeculectomy （Trabectome） surgery in Chinese open angle glaucoma patients.Methods Prospective non-comparative case series study.A total of 41 cases （34 primary open angle glaucoma patients,3 developmental glaucoma patients and 4 pigmentary glaucoma patients） were included in the study.All the cases underwent Trabectome,including 9 cases combined with phacoemulsification cataract extraction.Major outcomes include intraocular pressure （IOP）,number of glaucoma medications,secondary glaucoma surgery and postoperative complications.Criteria for successful operation were defined as IOP ≤ 21 mmHg（1 mmHg =0.133 kPa）,at least 20% IOP reduction in any two consecutive visits after 3 months with or without IOP-lowering drugs and no additional glaucoma surgery.IOP and number of glaucoma medications were compared to baseline using Wilcoxon signed-rank test with Bonferroni correction.Kaplan-Meier analysis was performed to analyze the success rate of surgery.Results In the all 41 patients,21 cases （51.2%） were followed up for up to 12 months.IOP was reduced from （22.5 ± 8.1） mmHg to （17.6 ± 6.4） mmHg （P =0.02）,meanwhile number of glaucoma medications was reduced from 2.0 ± 0.9 to 1.2 ± 0.9 （P =0.02） at 12 months.The success rate at one year was 85% and 4 cases required additional glaucoma surgery.Conclusions Trabectome has many advantages,such as shorter surgery time,simple post-operative care,less intraoperative and postoperative complications and clear IOP-lowering effect.But it slong-term efficacy is still need a large sample,long-term follow-up to verify.

关 键 词：青光眼 开角型 小梁切除术 眼内压 

分 类 号：R779.6[医药卫生—眼科]