改良切口小梁切除术治疗原发性急性闭角型青光眼的效果  

The efficacy of modified incision trabeculectomy on patients with primary acute angle closure glaucoma

作　　者：孙晓萍 陈霞 刘曦 朱冬梅 Sun Xiaoping;Chen Xia;Liu Xi;Zhu Dongmei(Department of Ophthalmology,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450007,China)

机构地区：[1]郑州大学附属郑州中心医院眼科,郑州450007

出　　处：《中华眼外伤职业眼病杂志》2024年第2期111-117,共7页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的评价改良切口小梁切除术治疗原发性急性闭角型青光眼(PACG)的临床效果。方法回顾性病例对照研究。分析郑州市中心医院2018年10月至2022年9月收治的PACG 142例(142只眼)的临床资料,按手术方法不同将患者分成传统组和试验组。传统组71例(71只眼)实施传统小梁切除术,试验组71例(71只眼)实施改良的巩膜隧道切口小梁切除术。术后随访6个月。比较两组手术前后眼压、视力、前房角结构变化及术后并发症情况。结果两组手术前后不同时间点眼压比较差异有统计学意义(F_(组间)=520.50,P<0.001;F_(时间)=49.50,P<0.001;F_(交互)=8.38,P<0.001),其中试验组术后5 d、3个月及6个月眼压分别为(16.14±3.76)、(16.32±3.59)、(14.93±2.48)、(15.06±2.69)mmHg(1 mmHg=0.133 kPa),均低于传统组的(19.56±4.03)、(20.11±4.27)、(17.41±3.56)、(17.64±3.42)mmHg(t=5.23、5.73、4.82、5.00,均P<0.001);试验组视力提高者59例(83.10%),视力不变者9例(12.68%),视力下降者3例(4.23%),传统组视力提高者49例(69.01%),视力不变者15例(21.13%),视力下降者7例(9.86%),试验组术后视力优于传统组(Z=1.99,P=0.046);术后6个月,试验组中央前房深度(ACD)、前房角开放距离500(AOD500)分别为(2.54±0.46)、(0.24±0.07)mm,均大于传统组的(2.39±0.43)、(0.21±0.06)mm(t=2.14、2.72,P=0.034、0.007);术后6个月,试验组虹膜晶状体接触距离(ILCD)为(0.42±0.13)mm,小于传统组的(0.47±0.15)mm(t=2.12,P=0.036);试验组术后并发症发生率14.08%(10/71)低于传统组的29.58%(21/71)(χ^(2)=4.99,P=0.025)。结论对PACG患者改良巩膜隧道切口小梁切除术治疗PACG,可明显降低眼压,有效改善ACD、AOD500、ILCD等前房角参数,显著提高视力,且术后并发症较少。Objective To evaluate the efficacy of modified trabeculectomy in the treatment of primary acute angle closure glaucoma(PACG).Methods This was a retrospective case-control study.The data of 142 eyes of 142 patients with PACG admitted to Zhengzhou Central Hospital from Oct.2018 to Sep.2022 were analyzed,and they were divided into the traditional group and the trial group based on different surgical methods.In the traditional group,71 cases(71 eyes)underwent traditional trabeculectomy,while the trial group of 71 cases(71 eyes)underwent scleral tunnel incision trabeculectomy.The follow-up time was 6 months after surgery.The changes in intraocular pressure,visual acuity,angle structure,and postoperative complications were compared between the two groups.Results There were statistically difference in intraocular pressure between the two groups at different time points(F_(interblock)=520.50,P<0.001;F_(time)=49.50,P<0.001;F_(interaction)=8.38,P<0.001).The intraocular pressure of the trial group was(16.14±3.76),(16.32±3.59),(14.93±2.48),(15.06±2.69)mmHg(1 mmHg=0.133 kPa)at 5 d,3 months and 6 months,which were lower than the(19.56±4.03),(20.11±4.27),(17.41±3.56),(17.64±3.42)mmHg in the traditional group(t=5.23,5.73,4.82,5.00;P<0.001).The visual acuity of the trial group improved in 59 cases(83.10%),remained constant in 9 cases(12.68%),decreased in 3 cases(4.23%),while the visual acuity of the traditional group improved in 49 cases(69.01%),remained unchanged in 15 cases(21.13%),decreased in 7 cases(9.86%),and the postoperative visual acuity of the trial group was better than that of the traditional group(Z=1.99,P=0.046).At 6 months after surgery,central anterior chamber depth(ACD)and anterior chamber angle opening distance at 500μm(AOD500)of the trial group were(2.54±0.46)mm and(0.24±0.07)mm,which were higher than(2.39±0.43)mm and(0.21±0.06)mm of the traditional group(t=2.14,2.74;P=0.034,0.007).At 6 months after operation,the iris lens contact distance(ILCD)of the trial group was(0.42±0.13)mm,which was smaller

关 键 词：切口 隧道 巩膜 小梁切除术 青光眼 闭角型 视力 结构 前房角 

分 类 号：R779.6[医药卫生—眼科]