小梁切开-切除术联合生物羊膜移植治疗先天性青光眼  

Trabeculotomo-ectomy combined with amniotic membrane grafting for the treatment of congenital glaucoma

作　　者：董敬民[1] 徐璐[1] 张良慧[1] 白燕慧[1] 李富责 

机构地区：[1]郑州大学第一附属医院眼科,450052

出　　处：《中华眼外伤职业眼病杂志》2016年第4期249-253,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：河南省科技攻关基金资助项目（112102310179）

摘　　要：目的探讨小梁切开一切除术（小梁切开与小梁切除联合手术）联合生物羊膜移植术治疗先天性青光眼的临床效果及安全性。方法先天性青光眼小梁切开一切除术联合生物羊膜移植术26例（47只眼），观察术后眼压、角膜直径、角膜透明度、眼轴长度、杯盘比、滤过泡情况及手术并发症，并分析其临床疗效。结果术前眼压（37．80±11．24）mmHg（1mmHg=0．133kPa），角膜直径（13．31±0．61）mm，42只眼（89．36％）术前有明显的雾状角膜水肿。术后随访12～24个月，平均（15．03±7．34）个月。最后一次随访眼压（16．41±2．91）mmHg，与术前相比，差异有统计学意义（t=10．402，P=0．000）。最后一次随访29只眼（61．70％）形成功能性滤过泡。术后3个月随访结果显示：眼轴较术前明显缩短（t=4．081，P=0．003），角膜直径及杯盘比手术前后差异无统计学意义（t=0．931，P=0．188；t=0．431，P=0．293）。术后37只眼（88．10％，37／42）角膜完全透明，5只眼（11．90％，5／42）角膜水肿较术前明显减轻。术后均无严重并发症发生。结论小粱切开一切除术联合生物羊膜移植术是一种安全有效的先天性青光眼的治疗方法。Objective To investigate the clinical efficacy and safety of trabeculotomo-ectomy （combined sugery of trabeculotomy and trabeculectomy） combined with amniotic membrane grafting for the treatment of primary congenital glaucoma. Methods Forty-seven eyes of 26 patients with primary congenital glaucoma were treated with the operation of trabeculotomo-ectomy combined with amniotic membrane grafting. The intraocular pressure, corneal diameter, transparency of cornea, length of sagittal axis, filter bleb, the ratio of cup to disc and complication were observed, and the therapeutic effect was analyzed. Results The preoperative intraocular pressure was （37.80 ~ 11.24） mmHg （ 1 mmHg =0. 133 kPa） , the preoperative corneal diameter was （ 13. 31 ＋ 0. 61 ） mm, and obvious corneal edema was in 42 eyes accounting for 89. 36%. The follow-up period was 12-24 months with an average of （ 15.03 ± 7.34 ） months. The intraocular pressure after surgery was （16.41± 2.91 ） mmHg and compared with that before surgery, the difference was statistically significant （t = 10. 402, P = 0. 000）. The functional filtering blet formed in 29 eyes accounting for 61.70% . After the follow-up of three months after the operation, the eye axis reduced significantly compared with the preoperative one （t = 4. 081, P = 0. 003 ）. The differences in corneal diameter and C/D ratio between before and after the operation were not statistically significant（ t = 0. 931, P = 0. 188 ; t = 0. 431, P = 0.293 ）. The cornea of 37 eyes （88.10%, 37/42） was transparent after the surgery and the corneal edema alleviated obviously in 5 eyes （ 11.9% , 5/42） after the surgery. No obvious complication occurred. Conclusion Trabeculotomo-ectomy combined with amniotic membrane grafting is a safe and eftective method for congenital glaucoma.

关 键 词：青光眼 先天性 小梁切开 切除术 生物羊膜移植术 

分 类 号：R779.6[医药卫生—眼科]