非穿透小梁手术术中和术后早、中期并发症及疗效分析

目的　评价非穿透小梁手术术中和术后早、中期并发症及临床疗效和安全性。方法16 8例 (2 5 8只眼 )原发性开角型青光眼患者 ,按年龄、性别、病情严重程度进行匹配后 ,随机分为两组 ,一组行非穿透小梁手术联合透明质酸钠凝胶植入术 (14 2只眼 ) ,另一组行小梁切除术 (116只眼 )。非穿透小梁手术组和小梁切除术组患者术前平均眼压分别为 (31 85± 4 83)mmHg(1mmHg =0 133kPa)和 (32 5 9± 4 6 2 )mmHg。对两组患者的术后眼压及术中、术后 3个月内的并发症进行对照研究。结果　 (1)眼压 :非穿透小梁手术组患者术后 7、14d ,1、3、6个月时 ,平均眼压分别为 (6 6 7± 2 4 3)mmHg、(11 4 2± 2 89)mmHg、(12 5 9± 2 2 4 )mmHg、(15 4 5± 1 82 )mmHg、(17 99± 1 80 )mmHg ;小梁切除术组患者眼压分别为 (4 87± 1 6 5 )mmHg、(10 4 8± 2 38)mmHg、(12 0 1± 2 83)mmHg、(15 0 1± 2 6 6 )mmHg、(17 4 8± 2 97)mmHg。术前、后 1～ 6个月 ,两组患者眼压差异无显著意义(t=1 2 8、1 78、1 5 5、1 6 0 ,P =0 2 0 2、0 0 77、0 12 4、0 112 )。术后 7d及 14d ,小梁切除术组平均眼压低于非穿透小梁手术组 ,差异有显著意义 (t=7 0 3、2 89,P <0 0 0 0 1、P =0 0 0 4 )。 (2 )视力 :两组患

Analysis of intra-operative and early post-operative complications and safety in non-penetrating trabecular surgery

OBJECTIVE: To evaluate the safety, effectiveness and complications of non-penetrating trabecular surgery (NPTS). METHODS A total of 168 patients ( 258 eyes) of primary open angle glaucoma were divided into 2 groups randomly, and they were matched according to the age, sex and severity of disease. NPTS with reticulated hyaluronic acid implant was taken in one group, and traditional trabeculectomy was taken in the other. Pre-a2operative mean intraocular pressure (IOP) in the NPTS group and trabeculectomy group was (31.85 +/- 4.83) and (32.59 +/- 4.62) mm Hg (1a(c)mm Hg = 0.133 kPa), respectively. The post-operative IOP and complications in these 2 groups were compared. RESULTS: (1) IOP: The mean IOP on post-operative 7th, 14th day, 1st, 3rd and 6th month was (6.67 +/- 2.43), (11.42 +/- 2.89), (12.59 +/- 2.24), (15.45 +/- 1.82), and (17.99 +/- 1.80) mm Hg respectively in the NPTS group, while that in the trabeculectomy group for the same time a(c)series was (4.87 +/- 1.65), (10.48 +/- 2.38), (12.01 +/- 2.83), (15.01 +/- 2.66), an.d (17.48 +/- 2.97) mm Hg respectively. Statistically significant differences between these 2 groups were found on the post-operative 7th day and 14th day (t = 7.03, 2.89; P < 0.000 1, P = 0.004). However, significant difference was not noted for pre-operative and other post-operative IOP in the follow-up (t = 1.28, 1.78, 1.55, 1.60; P = 0.202, 0.077, 0.124, 0.112). (2) Visual acuity: There were no statistical differences of visual acuity between the 2 groups (kappa(2) = 0.135, 0.151, 0.024, 0.076; P = 0.935, 0.927, 0.988, 0.963). (3) Complications: I and II degree shallow anterior chamber was encountered in 57 eyes in the NPTS group, while that in the trabeculectomy group was 70. Twelve eyes with III degree shallow anterior chamber were found exclusively in the trabeculectomy group. Ciliary body or choroidal detachment was found in 66 and 70 eyes respectively in the NPTS and trabeculectomy group. Hypotony was encountered in 5 eyes exclusively in the trabeculectomy group. Complications were found to be statistically different in 2 groups (kappa(2) = 9.95, 15.27, 4.60, 6.19; P < 0.05). Hyphema was found in 2 and 6 eyes respectively in the NPTS and trabeculectomy group. Light anterior uveitis was found in 5 and 9 eyes respectively in the NPTS and trabeculectomy group. Vitreous extrusion was experienced in 1 eye of trabeculectomy group. Some complications (16.2%) related to operative skill were also experienced in the NPTS group. CONCLUSIONS: Over-filtration and surgical injury related complications are significantly reduced in the NPTS group compared to those in the trabeculectomy group. NPTS is safer than traditional trabeculectomy. Mastering surgical skills is required for reducing complications of NPTS.