小梁切除术两种结膜瓣的对比研究

目的 比较以角膜缘为基底(LBCF)和以穹窿为基底(FBCF)的结膜瓣这两种小梁切除术的降眼压效果、滤过泡形态及两种术式的并发症.方法 对象为原发性开角型青光眼和原发性慢性闭角型青光眼接受小粱切除术的49例60只眼.其中LBCF组35只眼,FBCF组25只眼.观察术前术后眼压和滤过泡形态及术后并发症.结果 两组术前眼压相似差异无统计学意义(P>0.05),术后6个月眼压FBCF组是(12.0±3.2)mmHg,LBCF组是(14.4±5.2)mmHg,差异有统计学意义.以眼压低于21mmHg为标准,FBCF组的完全成功率是96%,LBCF组的是83%,差异无统计学意义(P>0.05).以眼压低于18mmHg为标准,FBCF组的完全成功率是96%,LBCF组是74%,差异有统计学意义(P<0.05).浅前房、脉络膜脱离、滤过泡包裹和结膜伤口漏在两组的发生率相似.滤过泡形态LBCF主要以边界清晰的微小囊泡型为主,上方一般有明显界限;FBCF主要以弥散型为主,滤过向后方和鼻侧或颞侧弥散,上方一般无明显界限.结论 两种类型的结膜瓣形态,降压效果不同.

Limbus-Based versus Fornix-Based Conjunctival Flaps in Trabeculectomywith MMC.

Objective To evaluate the efficacy and bleb morphology of fomix-based conjunctiva flap (FBCF) versus limbus-based conjunctiva flap (LBCF) in trabeculeetomy with MMC. Methods 60 eyes with primary open angle glaucorna(POAG) or primary angle closure glaucoma (PACG) were included. 35 eyes had LBCF and 25 eyes had FBCF trabeculectomy with MMC. IOP before treatment and post treatment were recorded as well as morphology of bleb. Results Intraocular pressure (IOP) before treatment in both groups was similar (P>0.05). Mean IOP 6 months after treatment was (12.0±3.2)mmHg in FBCF and (14.4±5.2)mmHg in LBCF which is significantly different(P=0.039). The success rate(IOP lower than 21mmHg) was 96% in eyes with FBCF versus 83% in eyes with LBCF which was not significantly different (P=0.22). The success rate (lower than 18mmHg) was 96% in eyes with FBCF versus 74% in eyes with LBCF which was significantly different (P=0.035). Complications rates of shallow chamber, choroid detachment, encapsulated bleb and even early bleb leak were similar (P>0.05)in both groups. Morphology of FBCF tends to have more diffused and posterior bleb, while bleb of LBCF tends to have microcyst and have a ring of scar tissure. Conclusion: The morphology of two types of conjunctiva flap seems different and the success rate was different between the two types of flap.