小梁切除术联合前房增殖膜拦截技术治疗新生血管性青光眼的有效性和安全性  

Efficacy and safety of trabeculectomy combined anterior chamber proliferative membrane interception in neovascular glaucoma

作　　者：周孟田 朱树青 李昊宇 陈琪[1] 许淑霞 解彦茜 乐融融 王小洁 张绍丹 梁远波 Zhou Mengtian;Zhu Shuqing;Li Haoyu;Chen Qi;Xu Shuxia;Xie Yanqian;Le Rongrong;Wang Xiaojie;Zhang Shaodan;Liang Yuanbo(Wenzhou Medical University,Wenzhou 325027,China;The Eye Hospital,School of Ophthalmology and Optometry,Wenzhou Medical University,Wenzhou 325027,China;National Clinical Research Center for Ocular Diseases,Wenzhou 325027,China;Glaucoma Research Institute,Wenzhou Medical University,Wenzhou 325027,China)

机构地区：[1]温州医科大学,325027 [2]温州医科大学附属眼视光医院,325027 [3]国家眼部疾病临床研究中心,温州325027 [4]温州医科大学青光眼研究所,325027

出　　处：《眼科》2023年第1期21-26,共6页Ophthalmology in China

基　　金：浙江省“尖兵”“领雁”研发攻关计划(2022C03112)。

摘　　要：目的评价小梁切除术联合前房增殖膜拦截技术(AC-PMI)治疗新生血管性青光眼(NVG)的有效性和安全性。设计回顾性病例系列。研究对象温州医科大学附属眼视光医院小梁切除术联合AC-PMI的NVG患者28例(31眼)。方法回顾患者术前,术后1天、1周、1个月、3个月、6个月及12个月的病历资料。采用单因素重复测量方差分析比较手术前后眼压、抗青光眼药物使用数量。采用Kaplan-Meier生存分析评估手术累计成功率,在不使用任何抗青光眼药物时,眼压≤21 mmHg为手术完全成功;使用抗青光眼药物,眼压≤21 mmHg为手术条件成功。主要指标眼压、抗青光眼药物使用数量、术后并发症及手术成功率。结果平均随访(11.3±3.8)个月。术后12个月的平均眼压由术前的(51.3±8.3)mmHg下降至(14.2±5.0)mmHg(P<0.001)。抗青光眼药物使用数量由术前的2(2,3)种下降至0(0,0)种(P=0.002)。术后12个月手术累计完全成功率为72.6%、条件成功率为87.3%。低眼压、前房积血、浅前房、脉络膜脱离及角膜后弹力层脱离的发生率均为3.2%(1/31)。结论小梁切除术联合AC-PMI手术能有效降低和稳定NVG患者的眼压,是一种可选择的治疗NVG的联合手术方式。Objective To evaluate the safety and effectiveness of trabeculectomy combined with anterior chamber proliferative membrane interception(AC-PMI)on neovascular glaucoma(NVG).Design Retrospective case series.Participants Twenty-eight patients(31 eyes)with NVG who underwent trabeculectomy combined with AC-PMI in the Eye Hospital of Wenzhou Medical University.Methods Medical records of patients were reviewed and followed up at one day,one week,month 1,3,6,and 12-momth postoperatively.Repeated measured ANOVA was applied to compare pre-and postoperative intraocular pressure(IOP)and number of anti-glaucoma medication.Kaplan-Meier survival-curve analysis was used to evaluate cumulative probability of surgery success.Main Outcome Measures IOP,number of anti-glaucoma medication,surgery-related complications and success rate of operation.Results The mean follow-up was 11.3±3.8 months.The mean IOP decreased from(51.3±8.3)mmHg on 2(2,3)medications before surgery to(14.2±5.1)mmHg(P<0.001)on 0(0,0)medications(P=0.002)at 12 months post-operation,respectively.The cumulative complete success rate and qualified success rate were 72.6%and 87.3%at 12 months post-operation,respectively.The incidence of hypotension,hyphema,shallow anterior chamber,choroidal detachment and descemet’s membrane fold all were 3.2%(1/31).Conclusions Trabeculectomy combined with AC-PMI can effectively reduce and stabilize IOP in NVG patients,and is an alternative combined surgical approach for NVG.

关 键 词：新生血管性青光眼/外科学 

分 类 号：R779.6[医药卫生—眼科]