可调整缝线联合羊膜移植在小梁切除术中的应用

目的 :探讨可调整缝线联合羊膜移植治疗原发性闭角型青光眼的机理及疗效评价。方法 :5 2例 6 3眼原发性闭角型青光眼患者 ,随机分为治疗组 2 8例 36眼和对照组 2 4例 2 7眼 ,治疗组行可调整缝线联合羊膜移植小梁切除术 ,对照组行单纯小梁切除术 ,对术后前房、眼压、滤过泡、手术成功率及视力进行对照分析 ,随访 6月。结果 :浅前房发生率 :治疗组为 13.9% ,对照组为 4 8.5 % ,两组之间有显著性差异 (P <0 .0 1)。眼压 :两组术前与术后不同时期眼压比较有明显差异 (P <0 .0 5 ) ,术后 3月、6月两组眼压比较有显著性差异 (P <0 .0 5 )。滤过泡 :术后 2周功能性滤过泡治疗组占 97.2 % ,对照组占 74 .1% ;术后 6月分别为 91.7%和 6 2 .9% ,两组之间有显著性差异 (P <0 .0 5 )。手术成功率 :术后 2周治疗组为 97.2 % ,对照组为 81.5 % ;术后 6月分别为 91.7%和 6 2 .9% ,两组之间有显著性差异 (P <0 .0 0 5 )。术后视力 :术后 6月对照组视力下降有 10眼 (37.1% )而治疗组只有 4眼 (11.1% ) ,两组间有显著性差异 (P <0 .0 2 5 )。结论 :可调整缝线的应用减少了小梁切除术早期并发症的发生 ,羊膜可有效抗滤过道瘢痕 ,长期维持功能性滤过泡 ,两者联合应用大大提高了手术成功率。

Trabeculectomy with Use of Amnion and Releasable Sutures for Sclera Flap in Glaucoma

Objective: To discuss the value of release sutures for sclera flap and amnion transplantation in trabeculectomy for primary angle-closure glaucoma. Methods: 63 eyes of 52 cases primary angle-closure glaucoma were randomly divided into treatment group (36 eyes of 28 cases) and component group (27 eyes of 24 cases). The patients of the treatment group were undergone trabeculectomy with release sutures for sclera flap and amnion transplantation. The others were done trabeculectomy only. The depth of anterior chamber, intraocular pressure (IOP), belbs, success rate and visual acuity were observed after operation. The follow-up was 6 months. Results: The difference of shallow anterior chamber rate, IOP, functional bleb ,success rate and visual acuity before and after operation between two groups was significant. Conclusion: The use of releasable sutures for sclera flap could decrease the complication of trabeculectomy during the early postoperative period. Amniotic membrane could reduced proliferation of fibroblasts and scar tissue in trabeculectomy and maintain the functional bleb long time. The combine of them improved the success rate highly and cut down the complications.