非穿透性小梁手术治疗青少年开角型青光眼

目的探讨非穿透性小梁手术（NPTS）联合透明质酸钠生物胶（SK胶）植入治疗青少年开角型青光眼的临床疗效。方法对12例（22眼）青少年开角型青光眼采用非穿透性小梁手术联合SK胶植入,术中应用抗代谢药物。术后观察视力、眼压、滤过泡、眼底杯/盘、视野及手术并发症。随访36～44个月,并在末次随访时行超声生物显微镜（UBM）检查。结果手术1周及随访末次平均眼压分别为（10.27±1.38）mmHg,（16.18±7.69）mmHg,与术前平均眼压（29.38±12.56）mmHg相比,差异均有统计学意义（分别为t=6.65,P〈0.01和t=2.71,P〈0.01）。术后22眼均形成显著弥散滤过泡,末次随访时10眼（45.50%）可见扁平稍弥散滤过泡,12眼（54.50%）手术区瘢痕形成,未见滤过泡;视力提高2行及以上者5眼,不变者17眼,无视力下降。眼底杯/盘减小者6眼,不变者16眼;视野改善者6眼,不变者16眼,无视野损害进行性加重。结论非穿透性小梁手术联合透明质酸钠生物胶植入治疗青少年开角型青光眼疗效确切,并发症少,可作为青少年开角型青光眼的首选术式。

The clinical effect of non-penetrating traoccular surgery for treatment of juvenile open-angle glaucoma

Objective To evaluate the clinical effect of non-penetrating trabecular surgery （ NPTS） with reticulated sodium hyaluronate implant in juvenile open - angle glaucoma. Methods Methods NPTS with reticulated sodium hyaluronate implant and ant-fibroblastic drugs was performed on 22 eyes of 12 patients with juvenile open-angle glaucoma. Intraocular pressure（ IOP） ,visual acuity,filtering conjunctival bleb,cup/disc ratio,visual field and operative complications were following up for 36 to 44 mouths after operation. Ultrasound biomicroscopy was performed at the end of the follow-up. Results Mean IOP of 1 week post-operation and the end of the folle-up were significantly lower than that of pre-operation according to paired-samples t test （ t = 6. 65,P 0. 01 and T = 2. 71,P 0. 01） . Surgical outcome was defined as a success by the following criteria： complete success is IOP～21 mm-Hg （ 1 mmHg = 0. 133 kPa） without medication and no visual field deteioration; overall success is IOP～21 mmHg with medicatiou; failure is IOP 21 mmHg with medication. 12 eyes（ 54. 5%） were defined as a complete success and 10 eyes （45. 5%） were defined as a overall success at the end of the following-up. After operation,there was an obvious diffuse bleb in each eye,at the end of visit,there were functional blebs in 10 eyes,the successful filtra- tion was ceased in 12 eyes. Vision acuity of 5 eyes raised two lines or over,that of 17 eyes no changes; C/D of 6 eyes becomed smaller than ever,and that of 17 eyes no changes; visual field of 6 eyes becomed better than ever,and that of 16 eyes no changes. In operation,anterior chamber of 8 eyes becomed shallower,stump of schlemm tube of 2 eyes haemorrhaged; after operation,anterior chamber of 9 eyes becomed shallower,in 5 eyes there was a small amount of hyphemat that was absorbed in 3 ～ 5 days,there were no flare and cells in the anterior chamber in 8 eyes. Ultrasound biomi- cr0scpy was performed at the end of the follow - up,and it was shown that a transparent liquid space was existed and the hyaluronate gel implant was not seen. Conclusion Non-penetrating trabeuclar surgery with reticulated sodium hyaluronate implant can effectively lower the IOP and no serious complications commonly seen in the traditional trabeculectomy occur,should be the best choice for the treatment of patients with juvenile glaucoma.