非穿透性小梁手术与小梁切除术治疗青光眼的远期疗效对照研究

Objective To evaluate clinical outcomes of non-penetrating trabecular surgery (NPTS)and trabeculectomy surgery (TS) in the treatment of primary open angle glaucoma (POAG). Methods It was a case-control study.A total of 63 patients (63 eyes) with POAG were observed retrospectively.Thirty one eyes and 32 eyes underwent NPTS and TS,respectively.Intraocular pressure(IOP),filtration bleb,visual field and post-operative complications were observed for 6-60 months.The CMH X2 test was used to analyse the difference of them.Results After operation.the IOP in the NPTS group were from(13.87±4.88)mm Hg(1 mm Hg=0.133 kPa) to (24.01±6.55)mm Hg,the IOP in the TS group were from(11.90±4.92)mm Hg to(19.10±7.43)mm Hg.The IOP in the NPTS group was significantly higher than that in the TS group (F=5.137,P<0.05).The ratio of sustained filtration bleb of NPTS group after surgery was 25/31(80.6%),while 6/31 were flat filtration bleb.There were statistically significant difference in the rate of disappearance of filtration bleb between these two groups(X2=8.129,P<0.05).The difference of visual field loss postoperatively between these two groups was not statistically significant.The incidence rate of newly developed cataract after NPTS and TS was 6/31 and 12/32.respectively.The difierence of rate of complication between these two groups was statistically non-significant(X2=3.797,P<0.05).The successful rate after NPTS and TS was 61.54%(16/26)and 14.29%(4/28),respectively.The difference of successful rate between these two groups was statistically significant(X2=14.463,P<0.05).Conclusions Both NPTS and TS are effective methods for the treatment of POAG.Postoperative complications after NPTS are less than those of TS.But patients with TS could maintain a lower IOP than those with NPTS.Long-term efficacy of NPTS is uncertain.it's important to choose the suitable surgery to gain a high success rate.     

非穿透性小梁手术与小梁切除术治疗青光眼的远期疗效对照研究

Objective To evaluate clinical outcomes of non-penetrating trabecular surgery (NPTS)and trabeculectomy surgery (TS) in the treatment of primary open angle glaucoma (POAG). Methods It was a case-control study.A total of 63 patients (63 eyes) with POAG were observed retrospectively.Thirty one eyes and 32 eyes underwent NPTS and TS,respectively.Intraocular pressure(IOP),filtration bleb,visual field and post-operative complications were observed for 6-60 months.The CMH X2 test was used to analyse the difference of them.Results After operation.the IOP in the NPTS group were from(13.87±4.88)mm Hg(1 mm Hg=0.133 kPa) to (24.01±6.55)mm Hg,the IOP in the TS group were from(11.90±4.92)mm Hg to(19.10±7.43)mm Hg.The IOP in the NPTS group was significantly higher than that in the TS group (F=5.137,P<0.05).The ratio of sustained filtration bleb of NPTS group after surgery was 25/31(80.6%),while 6/31 were flat filtration bleb.There were statistically significant difference in the rate of disappearance of filtration bleb between these two groups(X2=8.129,P<0.05).The difference of visual field loss postoperatively between these two groups was not statistically significant.The incidence rate of newly developed cataract after NPTS and TS was 6/31 and 12/32.respectively.The difierence of rate of complication between these two groups was statistically non-significant(X2=3.797,P<0.05).The successful rate after NPTS and TS was 61.54%(16/26)and 14.29%(4/28),respectively.The difference of successful rate between these two groups was statistically significant(X2=14.463,P<0.05).Conclusions Both NPTS and TS are effective methods for the treatment of POAG.Postoperative complications after NPTS are less than those of TS.But patients with TS could maintain a lower IOP than those with NPTS.Long-term efficacy of NPTS is uncertain.it's important to choose the suitable surgery to gain a high success rate.     

非穿透性与改良小梁手术治疗开角型青光眼的远期疗效

目的:观察非穿透性与改良小梁手术治疗开角型青光眼的远期疗效。方法:开角型青光眼患者15例(30眼),同一患者1眼行非穿透性小梁手术,另眼行改良小梁切除术,术后观察眼压、滤过泡、视野、房角和视力情况。结果:通过对非穿透性小梁手术与改良小梁切除术治疗开角型青光眼术后眼压、滤过泡、视野、房角和视力情况的长期观察、比较,二者疗效无显著性差异,非穿透性小梁手术组并发症较少。结论:非穿透性小梁手术是治疗开角型青光眼的有效方法。     

非穿透性小梁切除术治疗开角型青光眼的远期疗效观察

目的　观察非穿透性小梁切除术 (non penetratingsurgery ,NPTS)联合透明质酸钠生物胶植入治疗原发性开角型青光眼 (POAG)的远期临床疗效。方法　对 4 1例 5 6眼POAG患者施行NPTS ,观察术后视力、眼压、滤过泡、手术区房角、手术并发症 ,随访 12～ 39个月 ,平均 16 .8个月。结果NPTS术后视力不变或提高 96 .4 3% ,眼压由术前平均(2 5 97± 7.97)mmHg(1kPa =7.5mmHg)降至术后 12个月平均眼压 (19.19± 3 6 6 )mmHg ,差异有显著性 (t=9.4 7,P <0 .0 1)。随访末期眼压≤ 2 1mmHg 31眼 ,需局部用降眼压药后眼压≤ 2 1mmHg 16眼 ,手术失败 8眼。随访末期有功能滤过泡 2 9眼 ,眼压均≤ 2 1mmHg。前房角镜检查 :术后 12个月可见较宽的透明间腔带 4 3眼 ,境界欠清 4眼 ,小梁膜色素沉着、增厚 7眼。 1眼生物胶露出球结膜后行羊膜移植修补。结论　NPTS能有效降低眼压 ,手术并发症少 ,术后视力稳定。手术失败的主要原因是巩膜瓣间、球结膜瘢痕化。     

非穿透性小梁切除术治疗开角型青光眼

目的研究非穿透性小梁切除术治疗开角型青光眼的手术效果、手术并发症及可能的降压机制.病人和方法男性27例,女性13例,共40例53眼.平均年龄41.87±20.92岁.其中原发性开角型青光眼24例(32眼)、先天性青光眼5例(8眼)、皮质类固醇性青光眼4例(6眼)、外伤性青光眼7例(7眼).手术在上方角巩膜缘做双层巩膜瓣,第二层巩膜瓣的深度为略暴露出点状葡萄膜组织,并向透明角膜区分离出1～2mm后弹力层,房水通过后弹力层渗出.剪除第二层巩膜瓣,手术不进入前房,术毕在巩膜瓣下注入透明质酸钠.术后观察病人前房反应、眼压及结膜滤枕情况.随访时间3～18个月.结果术中8眼穿破小梁一后弹力膜,术后前房反应轻,6眼发生前房出血,1眼出现羊脂状角膜后沉淀.17眼结膜形成滤过手术典型滤过泡,36眼结膜疏松,无滤过泡形成.各种青光眼的术后降压幅度较术前分别降低32.4～52.8%.结论非穿透性小梁切除术能很好的降低开角型青光眼病人的眼压.因术后并发症轻、少,可做为门诊青光眼病人和高危青光眼病人手术的选择.后巩膜葡萄膜的房水引流机制可能是该术式降压的机制之一.     

非穿透性小梁切除术的研究进展

原发性开角型青光眼（POAG）是一种常见的致盲性眼病，传统的小梁切除术是临床上治疗POAG的经典手术。但存在较多的并发症。随着手术技巧的改进及显微手术器械的发展，非穿透性小梁切除术（non-penetrating trabecular surgery．NPTS）由于保留了薄层的小梁组织而未直接进入前房，术后并发症减少，已经为越来越多的眼科医生所肯定。本文对目前NPTS的相关研究进展做一综述。希望能对医生们进一步了解NPTS有所帮助。     

非穿透性小梁切除术治疗开角型青光眼

目的 探讨小梁切除术改良方法,观察非穿透性小梁切除术疗效。方法 先作1/3～1/2厚度、大小约4 mm×3mm的浅层巩膜瓣,后于瓣下小梁区切除大小约2 mm×1 mm深层巩膜瓣及Schlemm管和近管组织,保留薄层巩膜于脉络膜,丝裂霉素C(0.08 mg/mL)棉片置于巩膜及球结膜瓣下3～5分钟,缝合球结膜。结果 随诊6～18月,眼压≤20 mmHg占95％(1 mmHg=0.133kPa),有效滤过泡95％;视力、视野无进一步损害。结论 非穿透性小梁切除术治疗开角型青光眼,效果好,并发症少。     

非穿透性小梁切除术23眼临床报告

目的 观察非穿透性小梁切除术后的疗效。方法 采用非穿透性小梁切除术的黏小管切开术式治疗中、晚期原发性开角型静光眼23例（33只眼）,随访3－6个月。结果 眼压控制≤21mmHg32只眼（97％）,无严重并发症。结论 非穿透性小梁切除术对原发性开角型青光眼的近、中期降眼压效果显著,安全性高。     

非穿透性小梁手术联合2种不同植入物治疗原发性开角型青光眼

目的研究非穿透性小梁手术(non-penetratingtra-becularsurgery,NPTS)联合透明质酸钠凝胶或羊膜植入术治疗原发性开角型青光眼(primaryopen-angleglaucoma,POAG)的临床效果。方法将42例(84眼)POAG患者随机分为A、B2组,每组21例(42眼)。A组行NPTS SKGEL植入,B组行NPTS 羊膜植入。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。患者术后随访6月~2a,平均(14.6±2.3)月。结果2组患者术后视力较术前无明显变化。A组患者术前平均眼压(40.3±8.7)mmHg(1kPa=7.5mmHg),术后(15.7±5.8)mmHg,差异有显著性意义(t=10.872,P<0.01);B组患者术前平均眼压(40.8±9·1)mmHg,术后(15.5±5.3)mmHg,差异有显著性意义(t=11·023,P<0.01)。A、B2组比较,无显著性差异。术后A组有1眼植入物脱出,B组有1眼轻微前房出血;2组均无浅前房、明显的眼内炎性反应及脉络膜脱离等并发症。术后患者经前房角镜检查,可见术区变薄的小梁网-后弹力膜窗,A组2眼、B组1眼可见小梁处微穿孔。结论NPTS联合SKGEL或羊膜植入术均能有效降低眼压,术后并发症少,是治疗POAG的有效方法。相比之下,羊膜取材容易、经济。     

非穿透性小梁切除联合羊膜移植治疗开角型青光眼及其远期疗效观察

目的探讨非穿透性小梁切除术(non-penetrating trabeculeetomy surgery,NPTS)联合羊膜移植治疗开角型青光眼的机理和疗效。方法对46例(58只眼)开角型青光眼行NPTR联合羊膜移植术,术后观察视力、眼压、前房深度、眼内反应、滤过泡及并发症,并做前房角镜检查。随访3个月-1年。结果术后炎症反应轻,并发症少,安全性较高,大部分患者眼压控制较满意,且比较经济;但也有小部分患者的远期疗效不令人满意,有眼压再升高可能。结论NPTR联合羊膜移植术较传统单纯行NPTR治疗开角型青光眼提高了眼压控制成功率,并发症少,较为安全有效。但控制眼压的长效性较穿透性小梁切除术为低。     

非穿透性小梁手术治疗原发性开角型青光眼的临床观察

目的　探讨非穿透性小梁手术 (non- penetrating trabecular surgery,NPTS)治疗原发性开角型青光眼 (primary open angle glaucoma,POAG)的临床疗效。方法　对 2 9例 (36只眼 )原发性开角型青光眼患者进行非穿透性小梁手术 ,术后 3天开始按摩眼球 ,持续 7～ 8周 ,观察视力、眼压、视野变化。结果　随访 4～ 9.5个月 ,平均 6 .41± 2 .5 3个月。术前平均眼压 2 8.14± 8.4m m Hg(1mm Hg=0 .133k Pa) ,术后 4个月平均眼压 14.9± 2 .3mm Hg。治疗前后眼压差异具有显著性意义 (P <0 .0 1)。所有病例术前、术后视力视野无显著性差异 (P >0 .0 5 )。术后前房出血 1只眼 ,浅前房 2只眼 ;无炎症、脉络膜脱离等并发症发生。结论　 NPTS是一种治疗 POAG安全、有效的手术方法     

非穿透小梁手术的术后早期并发症及成本-效果分析

目的评价非穿透小梁手术(NPTS)的术后早期并发症及成本效果。方法回顾性分析147例(215只眼)原发性开角型青光眼患者行滤过性手术后的临床资料,包括早期(住院期间)视力、眼压及并发症发生情况。其中NPTS组104只眼,改良小梁切除术(MT)组111只眼。根据所需治疗的例数(NNT)和手术效果,对预防不良事件的发生进行成本效果分析。结果(1)早期视力波动:术后视力下降两行以上者NPTS组25只眼(24.0%)、MT组26只眼(23.4%),两组间的视力变化差异无统计学意义(P>0.05)。(2)早期低眼压:术后第1天眼压≤5mmHg(1mmHg=0.133kPa)者NPTS组39只眼(38.2%),MT组10只眼(9.2%),两组间差异有统计学意义(P<0.01);出院时眼压≤5mmHg者分别为18只眼(27.5%)和19只眼(17.3%),两组间差异有统计学意义(P<0.05)。(3)前房出血:NPTS组20只眼(19.2%),MT组10只眼(9.0%);各组均有2只眼需行前房冲洗;两组间前房出血发生率的差异有统计学意义(P<0.05)。(4)早期浅前房:NPTS组发生Ⅱ°浅前房2只眼,Ⅰ°浅前房5只眼;MT组Ⅱ°浅前房5只眼,Ⅰ°浅前房5只眼;各组均未出现Ⅲ°浅前房者,两组间不同程度浅前房的发生率差异无统计学意义(P>0.05)。(5)其他并发症:NPTS组术中小梁穿透1只眼,遂改行小梁切除术;术后瞳孔散大6只眼;急性眼压升高1只眼;内滤口虹膜前粘连1只眼;低眼压性黄斑水肿1只眼。(6)成本效果分析:NPTS组对不良事件的绝对风险降低率(ARR)=3.0%,防止1例不良事件发生需治疗的病例数(NNT)=33.2例,较MT组多花费成本11.6万元;对于严重不良事件,NPTS组的绝对风险降低率=1.8%,NNT=55.5例,较MT组多花费成本19.4万元。结论NPTS可能在减少抗青光眼术后严重不良事件的发生方面具有一定作用,但与MT相比,其在减少并发症方面的成本较高;因此,基层医院眼科医师应重点掌握MT操作技术。     

小梁切除口大小与濾过手术疗效对比分析

目的 研究小梁切除術后淺前房發生率,眼壓下降的程度與小梁切除口大小的關系,探索適當的手術設計。方法 75只眼的濾過手術,按小梁切口的大小分0.75×0.75mm、1.0×1.0mm、1.5×1.5mm、2.0×1.5mm四組。按術后淺前房發生率和1月、3月、6月、12月眼壓狀態分别進行方差分析。結果 淺前房發生率與切除口大小呈正相關,與各組間眼壓下降程度無顯著差异。結論 小切口小梁切除術是更安全有效的手術方式。     

非穿透小梁切除羊膜植入术治疗开角型青光眼

目的：观察非穿透小梁切除加羊膜植入术治疗开角型青光眼的效果。方法：对66例（87眼）原发性开角型青光眼随机分为三组,分别采用非穿透小梁切除加羊膜植入术,复合式小梁切除术及非穿透小梁切除加透明质酸钠膜植入术,结果：非穿透小梁切除加羊膜植入术组与其它两组相比,术后视力恢复较好、眼压控制满意、并发症较少,结论：非穿透小梁切除加羊膜植入术是治疗开角型青光眼的有效方法。     

非穿透性小梁手术治疗青少年型青光眼的疗效分析

目的评价非穿透性小粱手术治疗青少年型青光眼的临床疗效。方法对20例(30只眼)青少年型青光眼患者采用非穿透小梁手术,联合应用抗代谢药物和可调节缝线。术后随访观察眼压、视力、滤过泡、杯/盘比值、视野及术后并发症。结果患者术后l周和末次随访时(术后6～24个月)的眼压与术前相比显著下降,经配对t检验,其差异有统计学意义(分别为t=13.10,P<0.01和t=10.35,P<0.01)。所有患者随访期间视力均达到或略优于术前。术后不用或使用5-Fu形成功能性滤过泡,杯/盘比值和视野无明显进展。结论非穿透性小梁手术联合术中、术后应用抗代谢药物及可调节缝线,对于青少年型青光眼的降眼压效果明显,并且安全性高,应作为青少年型青光眼的首选手术治疗方式之一。     

Tight versus loose scleral flap closure in trabeculectomy surgery

Thirty-two consecutive trabeculectomy patients were randomized to receive a tight scleral flap closure (15 eyes) with postoperative laser suture lysis, or a loose scleral flap closure (18 eyes) to determine differences in the surgical results. Three months postoperatively no statistical difference in intraocular pressure (loose closure 15.1 ± 3.3 mm Hg, tight closure 15.0 ± 3.6 mm Hg,p > 0.05) or number of glaucoma medicines (loose closure 1.6, tight closure 1.3,p > 0.05) existed between treatment groups. In the early postoperative period, no statistical difference between groups was observed in the anterior chamber depth, visual acuity or intraocular pressure (p > 0.05). Laser suture lysis was performed without complication in nine patients with a statistically significant reduction in intraocular pressure (p < 0.01). This study suggests, by the technique used, that no obvious benefit exists in using a tight versus a loose scleral flap closure when performing a trabeculectomy.     

反折式小梁切除术治疗青光眼

目的　改进常规小梁切除术,减少术后滤过道阻塞。方法　在常规小梁切除术的基础上,对拟切除的包括小梁在内的深层巩膜组织(4.0mm×1.5mm)不完全切除,而是保留一端,将其垂直扭转反折缝于其后方的深层巩膜组织之上,利用其隆起特点防止术后滤过道阻塞。结果　术后随访12～36个月,平均23.5个月。治疗组33例(38只眼),眼压从术前(25.41±2.41)mmHg(1mmHg=0.133kPa)降至术后(14.74±0.90)mmHg。对照组33例(40只眼),眼压从术前(24.96±1.35)mmHg降至术后(19.40±1.43)mmHg,治疗组手术成功率94.7％,对照组手术成功率77.5％。结论　采用反折式小梁切除术治疗青光眼,能有效减轻术后滤过道阻塞,从而有效控制眼压,减少复发,该术式易操作,且安全、有效。     

房水引流物植入术能否作为青光眼治疗的首选术式

随着青光眼房水引流物的不断改进和植入技术的逐渐娴熟,房水引流物植入术的应用范围有不断扩大的趋势.至于房水引流物植入术能否成为治疗青光眼的首选术式,目前尚存争议.因此,有必要分析和比较房水引流物植入术与常规小梁切除术的临床疗效,对引流物植入术的适应证及存在分歧的原因进行探讨.多数研究结果表明房水引流物植入术可以作为难治性青光眼的首选术式,其临床疗效优于小梁切除术,其有效性和安全性亦支持扩大应用于非难治性青光眼,但能否取代常规小梁切除术治疗原发性青光眼,目前尚无充分证据支持,尤其还缺乏我国相关的研究数据,尚待多中心的随机临床对照研究结果证实.