非穿透性小梁手术联合透明质酸钠生物胶植入术的临床疗效观察

目的观察非穿透性小梁手术(nonperforating trabecular surgery,NPTS)联合透明质酸钠生物胶植入术的临床疗效.方法对20例(28只眼)中、晚期开角型青光眼患者行NPTS联合透明质酸钠生物胶植入术.术后观察眼压、眼内反应和滤过泡,并做前房角镜及超声生物显微镜检查.结果术后随访4.5～18.0个月,平均(9.2±3.4)个月.术前平均眼压(28.1±10.2) mm Hg(1 mm Hg=0.133 kPa),术后(17.5±4.1) mm Hg;差异有非常显著性(t=5.776,P<0.001).术前平均用药(2.04±0.74)种,术后(0.71±0.71)种,差异有非常显著性(t=8.103,P<0.001).随访期间眼压≤21 mm Hg者27只眼(96.4%),其中12只眼(42.8%)不用抗青光眼药物,15只眼(53.6%)加用抗青光眼药物.眼压下降≥10 mm Hg者13只眼(46.4%),其中不加药者6只眼.术后14只眼无任何眼内反应;10只眼有轻微房水闪光,2～6 d消失;4只眼有少量前房积血,3～7 d消失.术后28只眼均形成显著弥散滤过泡;随访期间,19只眼有功能性滤过泡;9只眼于术后1.5～3.0个月功能性滤过泡消失.5只眼于术中发现小梁网处有小穿孔,但无虹膜膨出,术后经前房角镜检查可见3只眼有小穿孔;另4只眼术中未见小穿孔,但前房角镜下观察有小裂隙,1～8个月时,用超声生物显微镜检查可见生物胶未降解.结论 NPTS联合透明质酸钠生物胶植入术可有效降低眼压,并减少抗青光眼药物的应用,术后并发症少,为一种具有良好应用前景的抗青光眼新手术.

Nonperforating trabecular surgery with reticulated hyaluronic acid implant

OBJECTIVE: To evaluate the clinical results of nonperforating trabecular surgery (NPTS) with reticulated hyaluronic acid implant. METHODS: Twenty cases (28 eyes) of advanced open angle glaucoma (C/D = 0.86 +/- 0.14) underwent NPTS with reticulated hyaluronic acid implant. Postoperatively, the intraocular pressure (IOP), intraocular reactions and the bleb appearance were recorded, gonioscopy and ultrasound biomicroscopy were performed. RESULTS: The mean follow-up was (9.2 +/- 3.4) months. The mean IOP was (28.1 +/- 10.2) mm Hg preoperatively and (17.5 +/- 4.1) mm Hg postoperatively, the difference being significant (t = 5.776, P < 0.001). The number of drugs used for anti-glaucoma was (2.04 +/- 0.74) preoperatively, and (0.71 +/- 0.71) postoperatively (t = 8.103, P < 0.001). On the last visit, in 27 eyes (96.4%) the IOP was < or = 21 mm Hg, and among them, there were 12 eyes (42.8%) without anti-glaucoma medicine and 15 eyes with anti-glaucoma medicine. In 13 eyes (46.4%) the IOP was decreased > or = 10 mm Hg in which 6 eyes did not take any anti-glaucoma medicine and 7 eyes used anti-glaucoma medicine. There were no flare and cells in the anterior chamber in 14 eyes. In 10 eyes there was only slight flare that disappeared in 2-6 days. In 4 eyes there was a small amount of hyphema that was absorbed in 3-7 days. After operation, there was an obvious diffuse bleb in each eye, at the last visit, there were functional blebs in 19 eyes, the successful filtration was ceased in 9 eyes within 1.5-3 months. Intra-operatively, in 5 eyes microperforations occurred in the trabecular meshwork without iris prolapse, and after operation, under the gonioscope, the perforation could be observed in 3 eyes. In another 4 eyes, there was no intra-operative perforation, but a small fissure was seen by gonioscopy. In the post-operative 1-8 months, ultrasound biomicroscopy was performed, and it was shown that the implant was not degraded. CONCLUSIONS: The elevated IOP in patients with open angle glaucoma can be effectively reduced by NPTS, and the number of drugs used for anti-glaucoma was decreased. The post-operative complications were much less because of no intra-operative penetration of the anterior chamber. Therefore, NPTS is a very hopeful and practicable new anti-glaucoma surgery.