非穿透性小梁手术联合双层羊膜植入物治疗青少年型青光眼  

Effect of non-penetrating trabecular surgery with amniotic membrane implant on patiens with juvenile glaucoma

作　　者：刘兆荣[1] 王杰[2] 

机构地区：[1]山东省日照市人民医院眼科,276800 [2]山东省潍坊医学院附属医院眼科

出　　处：《中华眼科杂志》2004年第2期78-81,共4页Chinese Journal of Ophthalmology

摘　　要：目的　探讨非穿透性小梁手术 (NPTS)联合羊膜植入物治疗青少年型青光眼的临床效果。方法　对 2 6例 (32只眼 ) 12～ 2 8岁青少年型青光眼患者进行非穿透性小梁手术联合羊膜植入物治疗。术后观察患者眼压、眼内反应及滤过泡情况 ,并做前房角镜检查。患者术后平均随访时间 (8 3± 4 2 )个月。结果　患者术后视力较术前无明显变化。患者术前平均眼压 (2 8 6± 7 3)mmHg(1mmHg =0 133kPa) ,术后 (15 7± 3 7)mmHg ,差异有显著意义 (t=4 82 ,P <0 0 1)。术前用药2～5种 ,平均 3 2种 ;术后用药 0～ 2种 ,平均 0 8种 ,差异有显著意义 (秩和检验 ,t=12 8,P <0 0 1)。随访期间眼压≤ 2 1mmHg者 30只眼 (93 8% ) ,无需药物治疗而眼压正常者 18只眼 (5 6 3% ) ,用药后眼压保持正常者 12只眼 (37 5 % )。术后 6只眼有轻微前房出血 ;无前房变浅、眼部炎性反应、脉络膜脱离等并发症发生。术后患者经前房角镜检查 ,可见术区后弹力膜及残存小梁网变薄 ,5只眼可见小梁处有微穿孔。结论　NPTS联合羊膜植入术能有效降低眼压 ,减少抗青光眼药物的应用 ,术后并发症少 ,是治疗青少年型青光眼的有效方法之一。ObjectiveTo evaluate the ef fect of non-penetrating trabecular surgery (NPTS) with amniotic membrane implant in patients with juvenile glaucom a. Methods NPTS with amniotic membrane implant was performed o n 32 eyes of 26 p atients with juvenile glaucoma aged between 12～28 years. Intraocular pressure ( I OP) was measured pre-and post-operatively by CT-60 non-contact tonometer, i ntra ocular irritations and the bleb appearances were recorded, and the anterior cham ber angle of post-operation was observed by gonioscopy. Follow-up was (8.3± 4 .2) m onths after surgery. Results IOP of post-operation was signi ficantly decrease d (15.7±3.7) mm Hg(1 mm Hg=0.133 kPa; t=4.82, P<0.01) compared wit h that of pre -operation (2 8.6±7.3) mm Hg. The mean number of drug usage was significantly reduced to 0 .8 (t=128, P< 0.01) after surgery when compared with 3.2 before surgery. On the last visi t, the IOP was ≤21 mm Hg in 30 eyes (93.8%), among them, there were 18 eyes (56. 3%) without anti-glaucoma medication and 12 eyes (37.5%) with anti-glaucoma compo und s. There was a small amount of hyphema that was absorbed in 3～5 days in 6 eyes . The gonioscopy showed that the remnant trabecular meshwork and Descemet membrane were thinner at the surgical site, and microperforation occurred in the trabecu lar meshwork in 5 eyes. The complications such as flat chamber, inflammation an d choroidal detachment were not observed. There was no significant difference in visual acuity between pre-and post-operation. Conclusions〓 NPTS with amniotic m embrane implant effectively controls elevated IOP in patients with juvenile glau coma and reduced the number of anti-glaucoma drug usage without significant pos t -operative complications. NPTS with amniotic membrane implant is an effective an d new method for the treatment of patients with juvenile glaucoma.

关 键 词：非穿透性小梁手术 双层羊膜植入物 联合治疗 青少年型青光眼 术后视力 透明质酸 

分 类 号：R779.6[医药卫生—眼科]