多种术式联合手术治疗发育性青光眼的疗效研究  

Retrospective evaluation of trabeculotomy combined with Ahmed glaucoma valve implantation in the management of developmental glaucoma

作　　者：张晓利[1] 陈鹏[1] 戴涛[1] 王丽纯[1] 

机构地区：[1]郑州市第二人民医院眼科,450006

出　　处：《中华眼科医学杂志（电子版）》2014年第5期6-11,共6页Chinese Journal of Ophthalmologic Medicine(Electronic Edition)

摘　　要：目的探讨Schlemm管切开、窦小梁切开联合儿童型Ahmed青光眼引流阀植入术与Schlemm管切开、窦小梁切开联合窦小梁切除术治疗发育性青光眼的临床疗效。方法收集2010年1月至2013年1月郑州市第二人民医院眼科收治的29例（40只眼）发育性青光眼患儿的临床资料。按手术方法和病情将患儿分为实验组14例（14只眼）和对照组15例（26只眼）,实验组行Schlemm管切开、窦小梁切开联合儿童型Ahmed青光眼引流阀植入术;对照组行Schlemm管切开、窦小梁切开联合窦小梁切除术。观察、记录术后1周,1,2,6,12个月两组患儿眼压、角膜横径、杯盘比、盘周神经纤维层厚度、视野及术后并发症的发生情况。两组患儿的眼压以均数±标准差（x珋±s）的形式表示,采用两因素重复测量方差分析的方法进行组间比较,采用t检验进行组内比较。两组患儿手术前后角膜横径、杯盘比及并发症的发生情况采用卡方检验的方法进行比较。结果手术前实验组患儿的眼压为（46.12±9.87）mmHg（1 mmHg=0.133 kPa）,术后1周为（6.12±0.97）mmHg,术后1个月为（13.83±0.43）mmHg,术后2个月为（19.78±0.18）mmHg,术后3个月为（20.02±0.39）mmHg,术后6个月为（14.35±0.76）mmHg,术后12个月为（16.48±0.46）mmHg,术后各时间段的眼压与术前比较,差异有统计学意义（t1=15.09,12.23,9.98,9.89,12.00,11.22;P1〈0.05）。手术前对照组患儿的眼压为（45.56±8.49）mmHg,术后1周为（15.74±0.13）mmHg,术后1个月为（17.11±0.53）mmHg,术后2个月为（22.18±0.47）mmHg,术后3个月为（18.64±0.12）mmHg,术后6个月为（19.61±0.14）mmHg,术后12个月为（18.19±0.39）mmHg,术后各时间段的眼压与术前比较,差异有统计学意义（t1=17.91,17.05,14.02,16.17,15.58,16.42;P1〈0.05）。术后实验组患儿的眼压低于对照组,差异有统计学意义（F=19.20,P〈0.05）;实验组患儿眼压下降幅度高于对照组,差异有统计Objective To assess the clinical efficacy of opening the canal of Schlemm, combined trabeculotomy-trabeculectomy and the Ahmed glaucoma valve implantion combined with trabeculotomy for developmental glaucoma. Methods Medical records of 29 children （40 eyes） with developmental glaucoma who underwent Schlemm＇s canal opening combined trabeculotomy and Ahmed glaucoma valve implantation （experimental group, 14 patients and 14 eyes） or Schlemm＇s canal opening combined with trabeculotomy and trabeculectomy （control group, 15 patients and 26 eyes） consecutively in the Department of Ophthalmology, Second People＇s Hospital between January, 2010 and January, 2013 were reviewed. Data on visual acuity, intraocular pressure （IOP） ,corneal diameter,cup-disc ratio, disc peripheral nerve fiber layer thickness, and operative complications at 1 week, 1 month,2 months,6 months and 12 months were extracted and analyzed. Results In both groups, the average IOP was significantly decreased, in a time-dependent manner, as compared with that before treatment （P 〈0.05） ,but the decrease was more pronounced in the experimental group than in the control group （ P 〈0.05 ）. The average corneal diameter was significantly reduced after treatment in 8 （57.14%） eyes in the experimental group and in 15 （57.69%） eyes in the control group （P 〉0.05 ）. The average cup-disc ratio was reduced after treatment in 2 （ 14.28% ） eyes in the experimental group and in 14 （53.85%） eyes in the control group （P 〈0.05）. In the first 3 days after treatment, slight hyphema was observed in 8 （86.67%） eyes in the experimental group and in 20 （92.68%） eyes in the control group （P 〉0.05）. Postoperative iris adhesion occmTed in 5 （35.71%） and 4 （26.67%） eyes, respectively,in the experimeutal and control groups （P 〉0. 05 ）. There was no single case of descemet avulsion, lens damage, drainage valve exposure or drainage tube displacement in either group. Conclusions Both combination str

关 键 词：窦小梁切除术 窦小梁切开术 Schlemm管切开术 Ahmed青光眼引流阀 发育性青光眼 

分 类 号：R779.6[医药卫生—眼科]