巩膜瓣可调整缝线的小梁切除术对角膜散光的影响

目的 探讨巩膜瓣可调整缝线的小梁切除术对角膜散光的影响及术后屈光度稳定的时间.方法 收集2014年6月至2016年7月于我院眼科收治的70例原发性青光眼患者,将所有患者分为两组:试验组为联合可调整缝线的小梁切除术患者40例40眼,对照组为单纯小梁切除术者30例30眼.检查记录两组术前及术后1周(可调整缝线拆除前)、1个月、3个月的角膜地形图、角膜曲率、屈光度及眼压情况.结果 术后2组各时间点屈光度及眼压比较,差异均有统计学意义(均为P＜0.01).术后1周角膜散光:试验组(3.80±1.31)D和对照组(1.42±0.32)D与术前(1.48±0.79)D、(1.12 ±0.36)D相比,差异均有显著统计学意义(均为P＜0.01);试验组和对照组角膜散光术后1个月(1.50±0.71)D、(1.24 ±0.31)D及3个月(1.36±0.61)D、(1.09±0.34)D与术前相比,差异均无统计学意义(均为P＞0.05),术后1周试验组与对照组角膜散光相比差异有显著统计学意义(P＜0.01),术后1个月及3个月试验组与对照组角膜散光相比差异均无统计学意义(均为P＞0.05).两组术后1个月角膜散光虽较术后3个月时偏高,但差异均无统计学意义(均为P＞0.05).术后3个月试验组、对照组顺规性散光眼数分别是33眼、22眼(P=0.36).结论 可调整缝线的小梁切除术术后1周(可调整缝线拆除前)角膜散光度数明显增加,术后1个月散光度数明显减少,至3个月趋于稳定,术后3个月时角膜散光以顺规性散光为主.

Effects of trabeculectomy with removable suture in sclera flap on astigmatism of cornea

Objective To investigate the changes in corneal astigmatism after trabeculectomy using removable suture and the duration of postoperative diopter stabilization.Methods From June 2014 to July 2016,70 primary glaucoma patients (70 eyes) were enrolled and divided into two groups,including experimental group 40 patients (40 eyes) with trabeculectomy using removable suture and control group 30 patients (30 eyes) with trabeculectomy alone.Then,several variables of corneal topography,corneal curvature,diopter and intraocular pressure were recorded and analyzed before operation and 1 week (before removal of the suture),1 month and 3 months after surgery.Results In the two groups,postoperative diopter and intraocular pressure at each time point approached significant difference (all P ＜ 0.01).There was significant difference in comparison of corneal astigmatism 1 week after surgery (3.80 ± 1.31) D and preoperative corneal astigmatism (1.48 ± 0.79) D in experimental group,and this was true of the control group for corneal astigmatism 1 week after surgery (1.42 ± 0.32)] and preoperative data (1.12 ± 0.36) D (all P ＜ 0.05).Moreover,corneal astigmatism 1 month and 3 months after surgery in the experimental group was (1.50 ± 0.71) D and (1.36 ± 0.61) D,and this data in the control group was (1.24 ± 0.31) D and (1.09 ±0.34)D respectively,and their differences was not statistically significant compared with the control group (all P ＞ 0.05).There was significant difference in the corneal astigmatism 1 week after operation (P ＜ 0.01),while there was no significant difference in this variable 1 month and 3 months after operation between the two groups (all P ＞ 0.05).Although the corneal astigmatism 1 month after operation was enhanced compared with 3 months after operation,but the difference was not statistically significant (all P ＞ 0.05).In addition,the number of with-the-rule astigmatism in the experimental group and the control group were 33 eyes and 22 eyes respectively (P =0.36).Conclusion The corneal astigmatism caused by trabeculectomy using removable suture was significantly enhanced in the early period,but it decrease easily in 1 month after removing the suture,with keeping stable in 3 months and getting with-the-rule astigmatism 3 months after surgery.