小梁切除术联合生物羊膜移植治疗难治性青光眼的疗效

目的：评价小梁切除术联合生物羊膜治疗难治性青光眼的临床疗效。

方法：包括29例29眼具有高危因素如新生血管、葡萄膜炎、无晶状体、人工晶状体和发育性的难治性青光眼。13例行小梁切除术联合羊膜移植，16例行小梁切除术。术后观察、比较的指标包括：术后眼压、抗青光眼药物使用数量、滤过泡形态特点以及术后并发症。所有研究对象随访12mo。

结果：术后6mo，手术完全成功：羊膜组11/13(84.6%)，对照组10/16(62.5%)(P<0.05)； 术后12mo，手术完全成功：羊膜组10/13(76.9%)，对照组10/16(62.5%)(P<0.05)。术后12mo，羊膜组和对照组眼压分别从术前50.3±11.3，49.7±10.7mmHg降至15.7±1.1，19.8±2.3mmHg(P<0.05)。由于滤过过强，对照组术后早期出现低眼压3例(18.8%)，羊膜组无1例发生； 对照组出现包裹性滤过泡6例(37.5%)，羊膜组仅出现1例(7.7%)。

结论：小梁切除术联合羊膜移植治疗难治性青光眼与单纯小梁切除术相比，具有手术成功率高，术后眼压控制良好、平稳，术后并发症发生率低的特点。

Efficacy of trabeculectomy with amniotic membrane transplantation for refractory glaucoma

AIM: To evaluatethe clinical efficacy of trabeculectomy combined with amniotic membrane transplantation for refractory glaucoma.

METHODS: This study included 29 cases(29 eyes)with developmental refractory glaucoma at such high risks as neovascular,uveitis,aphakia, pseudophakic.Trabeculectomy with amniotic membrane transplantation was performed in 13 cases and trabeculectomy without amniotic membrane transplantation in 16 cases. The outcome measurements included postoperative intraocular pressure(IOP), the used quantity of antiglaucoma medications, the morphologic characteristics of the filtering blebs and complications. All patients were followed for 12mo.

RESULTS: Complete success was seen 11/13(84.6%)in study eyes and 10/16(62.5%)in aontrol eyes at 6mo postoperatively(P<0.05), and 10/13(76.9%)in study eyes and 10/16(62.5%)in control eyes at 12mo after surgery, respectively(P<0.05). IOP decreased from 50.3±11.3mmHg and 49.7±10.7mmHg preoperatively in study and control groups to 15.7±1.1mmHg and 19.8±2.3mmHg respectively at 12mo of postoperation(P<0.05). Early postoperative ocular hypotony developed in 3(18.8%)control eyes owing to excessive filtration but none of them in study eyes. Encapsulated bleb occurred in 6(37.5%)control eyes but only in 1(7.7%)study eyes.

CONCLUSION: In refractory glaucoma,trabeculectomy combined with amniotic membrane transplantation compared to trabeculectomy without amniotic membrane transplantation has higher success rates, better control of postoperative IOP, and less complication rates.