小梁切除联合羊膜植入和巩膜瓣松解缝线术治疗难治性青光眼  

Trabeculectomy with amniotic membrane transplantation and combining suture lysis of scleral flap in complicated glaucoma

作　　者：岳军[1] 胡长清[1] 雷小敏[1] 覃光海[1] 章艳[1] 

机构地区：[1]三峡大学仁和医院眼科,宜昌443001

出　　处：《中华眼科杂志》2003年第8期476-480,共5页Chinese Journal of Ophthalmology

摘　　要：目的　探讨小梁切除联合羊膜植入和巩膜瓣松解缝线术治疗难治性青光眼的疗效。方法　对完成追踪观察的 5 8例 (6 7只眼 )难治性青光眼患者施行小梁切除术 ,术中巩膜瓣下及结膜瓣下植入新鲜或贮存羊膜 ,联合应用巩膜瓣松解缝线术控制房水渗漏量。结果　术后随访 5～ 38个月 ,平均 19 5个月 ,其中≥ 12个月者占 79 1%。术后 12个月时 ,新生血管性青光眼的眼压由术前 (43 86± 7 12 )mmHg(1mmHg=0 133kPa)降至 (19 6 3± 2 5 7)mmHg(t=4 96 ,P <0 0 0 1) ,人工晶状体植入术后青光眼的眼压由术前 (40 31± 4 79)mmHg降至 (18 0 9± 2 2 1)mmHg(t=3 5 4 ,P <0 0 5 ) ,无晶状体性青光眼的眼压由术前 (37 94± 5 6 3)mmHg降至 (2 0 14± 3 15 )mmHg (t=5 12 ,P <0 0 5 ) ,青少年型青光眼的眼压由术前 (32 4 8± 3 98)mmHg降至 (16 5 4± 1 84 )mmHg(t=4 2 3,P <0 0 1) ,葡萄膜炎性青光眼的眼压由术前 (36 0 1± 4 13)mmHg降至 (18 11± 3 4 0 )mmHg(t=4 4 7,P <0 0 1) ,滤过性手术失败的青光眼眼压由术前 (34 4 3± 5 2 8)mmHg降至 (18 31± 1 5 2 )mmHg(t=2 0 5 ,P <0 0 5 ) ;患者手术前、后眼压比较 ,差异均有显著意义。功能性滤过泡形成率为 80 6 %。无排斥反应和严重并发症。结论?Objective To study and evaluate the outcome of trabeculectomy with amniotic membrane transplantation combining suture lysis of scleral flap in complicated glaucoma. Methods This operation was performed in 48 patients (67 eyes) with complicated glaucoma. Amniotic membrane was implanted under the scleral flap and the conjunctival flap and combined with suture lysis for scleral flap to control the outflow of the aqueous humor. Results Follow-up period ranged from 5 to 38 months (mean 19.5 months). The intraocular pressure (IOP) was lowered from (43.86±7.12) mm Hg (preoperative IOP) to postoperative (19.63±2.57) mm Hg (postoperative IOP) in neovascular glaucoma ( t =4.96, P <0.001); from (40.31±4.79) mm Hg to(18.09±2.21) mm Hg in glaucoma after IOL implant ( t =3.54, P <0.05); from (37.94±5.63) mm Hg to (20.14±3.15) mm Hg in aphakic glaucoma ( t =5.12, P <0.05); from (32.48±3.98) mm Hg to(16.54±1.84) mm Hg in juvenile glaucoma ( t =4.23, P <0.01); from (36.01±4.13) mm Hg to (18.11±3.40) mm Hg in uveitic glaucoma ( t =4.47, P <0.01); from (34.43±5.28) mm Hg to (18.31±1.52) mm Hg in glaucoma after failure of conventional filtering operation ( t =2.05, P <0.05). Statistical significant difference was found in the IOP before and after the operation. The rate of formation of functional bulb was 80.6%. There were no reject reaction and severe complications. Conclusion Trabeculectomy with amniotic membrane transplantation combining suture lysis of scleral flap is a useful method in complicated glaucoma.

关 键 词：小梁切除术 羊膜植入术 巩膜瓣松解缝线术 治疗 难治性青光眼 羊膜 缝合技术 

分 类 号：R779.6[医药卫生—眼科]