CO2激光辅助深层巩膜切除术与小梁切除联合羊膜植入术治疗原发性开角型青光眼的临床观察  

Clinical efficacy of CO2 laser-assisted sclerectomy surgery and trabeculectomy combined with amniotic membrane transplantation in treatment of primary open angle glaucoma

作　　者：闫晓伟[1] 唐广贤[1] 张恒丽[1] 李凡[1] 马丽华[1] 耿玉磊[1] 张金玲 YAN Xiaowei;TANG Guangxian;ZHANG Hengli;LI Fan;MA Lihua;GENG Yulei;ZHANG Jinling(Department of Glaucoma,Shijiazhuang No.1 Hospital,Shijiazhuang No.1 Eye Hospital,Shijiazhuang 050000,China)

机构地区：[1]石家庄市第一医院,石家庄市第一眼科医院青光眼科,石家庄050000

出　　处：《眼科学报》2020年第5期311-318,共8页Eye Science

摘　　要：目的:评估CO2激光辅助深层巩膜切除术(CO2 laser-assisted sclerectomy surgery,CLASS)治疗原发性开角型青光眼(primary open-angle glaucoma,POAG)的临床疗效,并应用超声生物显微镜(ultrasound biomicroscopy,UBM)探讨手术区域房水引流机制。方法:回顾性分析在石家庄市第一眼科医院青光眼科接受CLASS(28例28眼)与小梁切除联合生物羊膜植入手术(28例28眼)的POAG患者,分析两组手术前后视力、眼压变化,术后滤过泡形态、手术成功率及术后并发症情况。结果:平均随访13个月,两组术后各时间点眼压显著低于术前眼压,差异有统计学意义(P<0.001);小梁切除联合生物羊膜植入术组眼压较CLASS组眼压更低,差异有统计学意义(P<0.05)。CLASS组完全成功率为64.29%,小梁切除联合生物羊膜植入术组完全成功率为71.43%,差异无统计学意义(P>0.05)。滤过泡形态:CLASS组L型滤过泡12眼,H型滤过泡16眼;小梁切除联合生物羊膜植入术组L型滤过泡20眼,H型滤过泡8眼,差异有统计学意义(P<0.05)。两组术后并发症主要为脉络膜脱离、浅前房,两组并发症发生率差异有统计学意义(P<0.05)。结论:CLASS是一种简单、安全、有效的降眼压方法,经小梁网、巩膜、脉络膜途径引流房水,远期效果良好,是治疗POAG的有效方法。Objective:To assess the clinical efficacy of CO2 laser-assisted sclerectomy surgery(CLASS)on primary open angle glaucoma(POAG)and to assess the mechanism of aqueous humor drainage in the surgical area with ultrasound biomicroscopy(UBM).Methods:Clinical data of 28 POAG patients who underwent CLASS(28 eyes)and 28 cases receiving trabeculectomy combined with amniotic membrane transplantation(28 eyes)in Department of Glaucoma,Shijiazhuang No.1 Hospital were retrospectively analyzed.The visual acuity,intraocular pressure(IOP),bleb morphologic features,surgical success rate and complications were compared between two groups.Results:During the 13-month follow-up,the IOP was significantly declined after surgery in two groups(both P<0.05).The IOP in patients undergoing trabeculectomy combined with amniotic membrane transplantation was significantly lower than that in those receiving CLASS(P<0.05).The complete success rate of CLASS was 64.29%,which did not significantly differ from 71.43%in the trabeculectomy combined with amniotic membrane transplantation group(P>0.05).Bleb morphologic features:12 L-type bleb and 16 H-type bleb were observed in the CLASS group,which significantly differed from 20 L-type bleb and 8 H-type bleb in the;trabeculectomy combined with amniotic membrane transplantation group(P<0.05).Postoperative complications mainly included choroidal detachment and shallow anterior chamber.The incidence of postoperative complications significantly differed between two groups(P<0.05).Conclusion:CLASS surgery is a simple,safe and effective treatment for POAG.It yields long-term effect by performing the drainage of aqueous humor through trabecular meshwork,filtering intrascleral cavity,and suprachoroidal space.

关 键 词：CO2激光辅助深层巩膜切除术 小梁切除联合生物羊膜植入术 原发性开角型青光眼 超声生物显微镜 

分 类 号：R779.6[医药卫生—眼科]