基于UBM观察的CO2激光辅助深层巩膜切除术对开角型青光眼患者的治疗效果分析  

Efficacy of CO2 laser-assisted sclerectomy surgery with ultrasound biomicroscopy to patients with open-angle glaucoma

作　　者：闫晓伟 唐广贤 张恒丽 李凡 马丽华 耿玉磊 YAN Xiaowei;TANG Guangxian;ZHANG Hengli;LI Fan;MA Lihua;GENG Yulei(Department of Glaucoma,Shijiazhuang People’s Hospital,Shijiazhuang 050000,Hebei Province,China)

机构地区：[1]石家庄市人民医院青光眼科,河北省石家庄市050000

出　　处：《眼科新进展》2020年第9期840-844,共5页Recent Advances in Ophthalmology

基　　金：河北省省级科技计划自筹经费项目(编号:182777141)。

摘　　要：目的观察CO2激光辅助深层巩膜切除术(CLASS)治疗开角型青光眼(OAG)的临床效果,并应用超声生物显微镜(UBM)检查探讨手术区域房水引流途径。方法对25例(25眼)OAG患者行CLASS治疗,术后随访12个月,观察患者最佳矫正视力、眼压、滤过泡形态,同时对手术区域进行UBM检查,观察巩膜瓣下形成液间腔(巩膜池)的大小(前后长度和高度)、剩余后弹力层-小梁网膜(TDM)厚度的变化。结果随访12个月,手术前后最佳矫正视力差异无统计学意义(F=7.716,P>0.05)。术后1周眼压最低,之后逐渐回升,术后3个月趋于平稳,术后各时间点眼压与术前相比,差异均有统计学意义(均为P<0.05)。术后12个月,4眼具有功能性滤过泡,21眼为无功能性滤过泡。UBM检查可见所有患眼均形成巩膜池,均具有完整的TDM。随访期间,剩余TDM厚度未见明显变化(P>0.05)。术后1个月与术后3个月、6个月、12个月相比,巩膜池前后长度、巩膜池高度差异均有统计学意义(均为P<0.05);术后3个月、6个月、12个月两两相比,巩膜池前后长度、巩膜池高度差异均无统计学意义(均为P>0.05)。结论CLASS能有效降低眼压,远期效果良好,是一种治疗OAG的有效方法。UBM检查能清楚地显示CLASS术后主要通过小梁网、深层巩膜、脉络膜引流房水降低眼压,适合CLASS术后的随访。Objective To observe the effect of CO2 laser-assisted sclerectomy surgery(CLASS)in patients with open-angle glaucoma(OAG),and to assess the mechanism of aqueous humor drainage in the surgical area with ultrasound biomicroscopy(UBM).Methods Totally 25 OAG patients(25 eyes)underwent CLASS surgery.The patients were followed up for 12 months.The patients'visual acuity,intraocular pressure(IOP),and filtering blebs morphology were observed.At the same time,the operation area was examined by UBM.The following parameters were assessed,including the size of the intrascleral lake under the scleral flap(anteroposterior length and height),thickness of the residual trabecular-descemet membrane(TDM).Results During the 12-month follow-up,there was no significant difference in the best corrected visual acuity between preoperation and postoperation(F=7.716,P>0.05).Postoperatively,intraocular pressure(IOP)was the lowest one week after surgery,then gradually increased,and stabilized at three months.There was a significant difference in IOP at each time point after surgery and preoperation(all P<0.05).Functional filtering blebs were found in 4 eyes,localized or disappeared filtering blebs in 21 eyes.The UBM showed that the hypoechoic liquid space existed under the scleral flap in all of patients and complete TDM.During the follow-up,there was no significant difference in the thickness of remaining TDM(P>0.05).There were significant differences in the anteroposterior length and height of intrascleral lake between 1 month after operation and 3 months,6 months and 12 months after operation(all P<0.05),but there was no statistically significant difference between any two time points of 3 months,6 months,and 12 months after operation(all P>0.05).Conclusion CLASS can effectively reduce IOP in patients with OAG in long-term.UBM shows that it mainly reduces IOP through trabecular meshwork,filtering intrascleral cavity and suprachoroidal space,so UBM examination is suitable for follow-up of CLASS.

关 键 词：CO2激光辅助深层巩膜切除术 开角型青光眼 超声生物显微镜 非滤过泡依赖性眼内引流手术 

分 类 号：R775.2[医药卫生—眼科]