改良NPTS联合角膜基质透镜植入术治疗开角型青光眼的临床研究  

Clinical study of modified NPTS combined with corneal refractive lenticule implantation in the treatment of open-angle glaucoma

作　　者：李霞 刘雪珂 甘霈 杨燕川 肖云 刘毅 雷代坤 高晓唯 周瑛 邓月 林芳 李文静 Li xia;Liu Xueke;Gan Pei;Yang Yanchuan;Xiao Yun;Liu Yi;Lei Daikun;Gao Xiaowei;Zhou Ying;Deng Yue;Lin Fang;Li Wenjing(Department of Ophthalmology,Xinjiang 474 Hospital,Urumqi 830013,China;Graduate School of Xinjiang Medical University,Urumqi 830013,China;Graduate School of Shihezi University,Shihezi 832000,China)

机构地区：[1]新疆四七四医院眼科,乌鲁木齐830013 [2]新疆医科大学 [3]石河子大学

出　　处：《临床眼科杂志》2023年第4期335-340,共6页Journal of Clinical Ophthalmology

基　　金：新疆军区总医院重点项目(2020jzbj1002,2022jzbj118);乌鲁木齐市卫生计生委科技计划项目(201841)。

摘　　要：目的研究改良非穿透性小梁手术(NPTS)联合角膜基质透镜治疗开角型青光眼的临床效果及其术后随访中的作用。方法回顾性病例对照研究。甘油冷冻保存角膜基质透镜[来源于临床治疗近视的飞秒激光微小切口角膜基质透镜切除术(SMILE)],在新疆四七四医院眼科就诊开角型青光眼患者。将2018年1月至2021年1月采用NPTS联合角膜基质透镜植入术治疗的45例(50只眼)设为观察组;将2006年1月至2007年1月采用NPTS联合透明质酸生物生物胶治疗的44例(50只眼)设为对照组。术后比较两组间视力、眼压、并发症及滤过泡形态,随访时间12个月评价综合临床疗效。随访时(1、3、6、12个月)进行眼前节照相、房角镜检查及超声生物显微镜(UBM)观察残留的小梁网-狄氏膜、巩膜池和滤过泡等情况,如果有滤过泡有包裹趋势,球结膜下5-氟尿嘧啶(5-FU)或行Nd:YAG激光房角穿孔术。结果术前平均眼压:观察组(32.80±9.32)mmHg,对照组(33.00±8.34)mmHg,术后第1天眼压,观察组平均(8.53±2.70)mmHg,对照组平均(9.27±2.12)mmHg,其后观察组术后1 d、1周、1个月、3个月眼压平均值与对照组差异均无统计学意义(均P>0.05),6个月、12个月眼压平均值显著低于对照组,差异均具有统计学意义(均P﹤0.05)。末次随访时,观察组:完全成功41只眼(82.0%),条件成功6只眼(12.0%),失败3只眼(6.0%),术后未出现浅前房,1眼前房少许出血,1只眼上皮一过性缺失,滤过泡菲薄10只眼;球结膜下注射5-FU 10只眼,行Nd:YAG激光房角穿孔术3只眼。对照组:完全成功40只眼(80.0%),条件成功5只眼(10.0%),失败5只眼(10.0%);术后1只眼发生浅前房,1只眼脉络膜脱离,2只眼前房少许出血,滤过泡菲薄3只眼。两组均无明显前房炎性反应、持续性低眼压及脉络膜上腔出血等并发症发生。球结膜下注射5-FU 1只眼,行Nd:YAG激光房角穿孔术2只眼。UBM可以清晰地观察到残留的小梁网-狄氏�Objective To investigate the clinical effect of modified nonpenetrating trabecular surgery(NPTS)combined with corneal refractive lenticule implantation in the treatment of open-angle glaucoma.Methods A retrospective case-control study.45 cases(50 eyes)with open-angle glaucoma who were treated with NPTS combined with corneal refractive lenticule implantation from January 2018 to January 2021 were collected as the observation group.44 cases(50 eyes)with open-angle glaucoma who were treated with NPTS combined with hyaluronic acid biological from January 2006 to January 2007 were collected as the control group.The visual acuity,intraocular pressure(IOP),complications,and filtering bleb morphology were compared between the two groups after the surgery,and the comprehensive clinical efficacy was evaluated at 12 months after the surgery.During follow-up(1 month,3 months,6 months,12 months),anterior segment photography,gonioscopy,and ultrasound biomicroscopy(UBM)were performed to observe the residual trabecular mesh-dieldri membrane,scleral cistern,and filtering vesicles.Subconjunctival injection of 5-Fluorouracil(5-Fu)or Nd:YAG laser anterior chamber angle puncture for hyperplasia of filtering vesicles hypertrophy uplift and a parcel trend.Results The mean intraocular pressure in the observation group and control group was(32.80±9.32)mmHg and(33.00±8.34)mmHg,respectively.The mean intraocular pressure in the observation group was(8.53±2.70)mmHg,and that in the control group was(9.27±2.12)mmHg at the first day after the operation,and there was no significant difference between the two groups(at 1 day,1 week,1 month and 3 months after the operation)(P>0.05).In the observation group,the means IOP at 6 months、12 months were significantly lower than that of the control group(P<0.05).At the last follow-up,41 eyes(82.0%)were a complete success,6 eyes(12.0%)were conditionally successful,and 3 eyes(6.0%)were failures.No eye had shallow anterior chamber.1 eye’s anterior chamber showed slight bleeding,1 eye had transient ep

关 键 词：角膜基质透镜 非穿透性小梁切除术 原发性开角型青光眼 

分 类 号：R779.6[医药卫生—眼科]