改良的扇形巩膜瓣半隧道切口行复合小梁切除术治疗原发性闭角型青光眼的临床疗效  

Compound trabeculectomy with modified fan-shaped scleral flap and half-tunnel incision for primary angle closure glaucoma

作　　者：胡佩宏 刘新华[1] 裴重刚[1] 黄歆[1] 邵毅[1] 李汉林[1] 张颖[1] 

机构地区：[1]南昌大学第一附属医院眼科,江西省南昌市330006

出　　处：《眼科新进展》2016年第8期738-741,共4页Recent Advances in Ophthalmology

基　　金：江西省卫生计划委员会科技计划项目(编号:20151036)~~

摘　　要：目的探讨改良的扇形巩膜瓣半隧道切口行复合小梁切除术治疗原发性闭角型青光眼的临床疗效。方法采用病例对照研究方法对118例原发性闭角型青光眼患者进行分组。对照组58例（76眼）采用三角形巩膜瓣的复合小梁切除术;观察组60例（78眼）采用改良的扇形巩膜瓣半隧道切口的复合小梁切除术。记录两组患者的临床效果、术后是否浅前房、眼压情况、滤过泡形态等。结果术后对照组浅前房发生率为18.42%,观察组浅前房发生率为1.28%,两组差异有统计学意义（χ2=12.862,P=0.000）。术后1周和6个月,对照组患者眼压分别为（13.32±4.41）mm Hg（1k Pa=7.5 mm Hg）和（14.62±3.50）mm Hg,观察组患者眼压分别为（13.29±4.08）mm Hg和（14.67±3.71）mm Hg;眼压随时间推移有升高趋势;两组患者眼压比较,差异无统计学意义（F=0.003,P=0.953）。术后1个月对照组功能性滤过泡占78.95%,观察组功能性滤过泡占92.31%,两组差异有统计学意义（χ2=5.611,P=0.018）。结论采用改良的扇形巩膜瓣半隧道切口行复合小梁切除术治疗原发性闭角型青光眼,操作简便,浅前房发生少,术后降压效果及滤过泡形成好,手术成功率高。Objective To evaluate clinical outcomes of compound trabeculectomy with modified fan-shaped scleral flap and half-tunnel incision for primary angle closure glaucoma.Methods It was a case-control study. A total of 118 cases（ 154 eyes） with acute primary angle closure glaucoma were observed retrospectively and divided into the control group（ 58 cases,76 eyes,triangle cleral flap compound trabeculectomy） and treatment group（ 60 cases,78 eyes,modified fan-shaped scleral flap and half-tunnel during operation）. Anterior chamber,intraocular pressure（ IO P） and filtering bleb were observed. Results After operation,the incidence of shallow anterior chamber in the control group and treatment group were 18. 42% and 1. 28%,respectively,the difference was statistically significant（ χ2= 12. 862,P = 0. 000）. IO P at postoperative 1w eek and 6 months in the control group were（ 13. 32 ± 4. 41） mm Hg and（ 14. 62 ± 3. 50） mmHg（ 1 k Pa = 7. 5 mm Hg）,respectively,which in the treatment group were（ 13. 29 ± 4. 08） mmHg and（ 14. 67 ± 3. 71） mm Hg,respectively,the difference was not statistically significant（ F =0. 003,P = 0. 953）. The ratio of sustained filtering bleb at postoperative 1 month in the control group and treatment group was 78. 95% and 92. 31%,respectively,there were statistically significant difference betw een tw o groups（ χ2= 5. 611,P = 0. 018）. Conclusion C ompound trabeculectomy with modified fan-shaped scleral flap and half-tunnel incision for primary angle closure glaucoma can reduce the incidence of shallow anterior chamber,decrease IO P effectively,form functional filtering bleb and reduce the operative procedure,and it ＇s a feasible operative approach.

关 键 词：闭角型青光眼 小梁切除术 巩膜瓣 

分 类 号：R775.2[医药卫生—眼科]