改良的黏弹剂Schlemm管切开术治疗原发性开角型青光眼的临床研究

目的观察改良的黏弹剂Schlemm管切开术（VCO）和小梁切除术（TE）治疗原发性开角型青光眼的疗效和安全性。方法采用前瞻性随机对照方法,对100例（100只眼）药物控制眼压不理想的原发性开角型青光眼患者,随机分为改良VCO组50例（50只眼）,TE组50例（50只眼）,术后平均随访28个月。结果手术后1个月,改良VCO组和TE组患者的平均眼压分别为（11．22±4．34）和（12．35±3．79）mmHg（1mmHg=0．133kPa）,手术成功率（术后未用任何降眼压药物眼压〈21mmHg）均为98．0％;手术后12个月,两组的平均眼压分别为（14．50±3．22）和（16．58±4．73）mmHg,手术成功率分别为87．5％和70．0％,两组差异有统计学意义（P〈0．05）;手术后24个月,两组的平均眼压分别为16．0和15．4mmHg,手术成功率分别为76．1％和67．3％,两组差异无统计学意义（P〉0．05）;早期并发症如浅前房、脉络膜脱离、囊样滤过泡等以TE组明显多于改良VCO组,两组差异有统计学意义（P〈0．01）。结论在治疗原发性开角型青光眼方面,改良VCO组的成功率较TE组高．术后早期并发症相对较少.

Modified viscocanalostomy for the surgical treatment with primary open angle glaucoma

OBJECTIVE: To compare the clinical outcome of trabeculectomy with viscocanalostomy in patients with primary open angle glaucoma (POAG). METHODS: 100 patients (100 eyes) with uncontrolled POAG were randomly assigned to either trabeculectomy group (50 eyes) or viscocanalostomy (VCO) group (50 eyes) and followed up for average 28 months. Intraocular pressure (IOP) was measured with a non-contact Topcon CT80 tonometer. RESULTS: At 1 month after operation, IOP was (11.22 +/- 4.34) and (12.35 +/- 3.79) mmHg (1 mmHg = 0.133 kPa, n = 50) in the eyes undergoing VCO or trabeculectomy surgery, respectively. The complete success rate (IOP < 21 mmHg without antiglaucoma medications) was 98.0% in both groups. There was no significant difference in IOP and complete success rate between both groups. At 12 months, IOP in VCO group was significantly (P < 0.05) lower (14.50 +/- 3.22) than that in trabeculectomy group (16.58 +/- 4.73) mmHg, while the complete success rate in VCO group (87.5%) was significantly higher (P < 0.05) than that in trabeculectomy group (70.0%). The early transient complications such as shallow anterior chamber and encysted blebs were significantly (P < 0.01) more common in trabeculectomy group than in VCO group. CONCLUSIONS: VCO appears to have long term advantages over trabeculectomy in terms of complete success rate, IOP control, and less early transient postoperative complications in POAG.