小梁切除术术中房水滤过量与术中及术后早期眼压无关

目的 测量小梁切除术术中房水滤出量，并分析其与术中眼压和术后早期眼压之间的关系。设计 前瞻性观察性研究。研究对象 2009年12月-2010年8月初次接受小梁切除术的82例（82眼）青光眼患者。方法 （1）将不同体积的生理盐水加到泪液检测滤纸条上的指定位置，然后观察滤纸吸水长度与液体量之间的关系。（2）前瞻性纳入初次小梁切除术的青光眼患者，术者遵统一程序行标准小梁切除术，关闭巩膜瓣前房注水稳定后采用Tonopen测量术中眼压。术中在关闭巩膜瓣，前房注水后60 s将泪液检测滤纸条置于巩膜瓣口处测量房水滤出量，持续80 s。分析术中滤过量与术中眼压及术后第1日及第7日眼压之间的关系，并观察术后滤过泡隆起度、范围及并发症情况。主要指标 滤纸湿线长度，术中及术后早期眼压，滤过泡情况。结果 滤纸吸水长度与液体量具有显著相关性，液体的体积可根据滤纸上湿线的长度通过以下公式计算：吸液体积（μl）=1.0434×吸液长度（mm）+2.4086（R2= 0.97）。82例患者（82眼）术前眼压（32.3±9.0）mmHg。根据术中滤纸吸水长度，将患者分为3组：第一组患者的吸水长度≤5 mm（n=46），第二组6~10 mm（n=18），第三组≥11 mm（n=18）。三组患者术中眼压分别为（13.9±8.3）mmHg、（12.1±5.4）mmHg、（12.1±6.5）mmHg（P=0.543）。术后第1天三组的眼压分别为（13.3±7.9）mmHg、（12.7±7.3）mmHg、（15.9±9.0）mmHg；术后1周，三组眼压分别为（12.2±6.9）mmHg、（10.7±5.6）mmHg、（13.1±8.1）mmHg，三组间术后早期眼压及滤过泡情况差异均无统计学意义（P均>0.05）。术后未观察到浅前房等其他并发症。结论 滤纸吸水长度与滤出液体量具有显著相关性。小梁切除术术中的滤出量可通过泪液检测滤纸条定量测量。但不能通过术中滤过量这个因素直接判定术后早期的眼压。（眼科， 2014, 23： 94-98）

No relationship between filtration amount in trabeculectomy and intraoperative and early postoperative intraocular pressure

 Objective To study the amount of filtration in primary trabeculectomy and the association of filtration amount with intraoperative and early postoperative intraocular pressure (IOP). Design Prospective observational study. Participants 82 cases of glaucoma patients underwent primary trabeculectomy between December 2009 and August 2010 were included. Methods 1. Add different volume of normal saline on the specified location of sterilized filter papers for Schirmer’s test, then observe the correlation of volume of fluid with the wet length. 2. Prospectively enrolled consecutive patients with primary open-angle or angle-closure glaucoma who underwent primary trabeculectomy. Use Tonopen to measure the intraoperative IOP after closure of the scleral flap. Use sterilized filter papers to measure the amount filtration 60 s after injecting BSS through the paracentesis. Wait for 80 s to get the readings. Analysis the relationship between filtration amount and intraoperative IOP, postoperative IOP at 1 and 7 days after surgery. Observe the height and range of filtering bleb and complications. Main Outcome Measures Wet length of the filter paper, intraoperative IOP, early postoperative IOP and the height, range and complications of filtering bleb. Results The wet length of the filter paper was significantly associated with the liquid volume. The liquid volume can be calculated by the following equation: Volume (μl) = 1.0434 × Length (mm) + 2.4086 (R2 = 0.97). In Eighty-two consecutive eligible patients (82 eyes) who underwent primary trabeculectomy, mean preoperative IOP was 32.3±9.0 mmHg. According to the intraoperative wet length of the filter paper, the patients were divided into three groups: group 1(≤5 mm, n=46), 2 (6~10 mm, n=18), and 3 (≥11 mm, n=18). The intraoperative IOP of the three group was 13.9±8.3 mmHg, 12.1±5.4 mmHg,12.1±6.5 mmHg, respectively (P=0.543). At 1d postoperatively, the IOP was 13.3±7.9 mmHg, 12.7±7.3 mmHg, 15.9±9.0 mmHg, respectively. At 7d postoperatively, the IOP was 12.2±6.9 mmHg, 10.7±5.6 mmHg, 13.1±8.1 mmHg, respectively. The postoperative IOP among these three groups had no significant differences (all P>0.05). There were no shallow anterior chamber postoperatively. Conclusion The wet length of the filter paper is significantly associated with the liquid volume. In trabeculectomy, the filtration amount can be measured by the filter papers for Schirmer’s test. Filtration amount during trabeculectomy can not be independently used to determine the intraoperative IOP and predict the early postoperative IOP. (Ophthalmol CHN, 2014, 23: 94-98)