摘要
目的比较非穿透小梁手术和改良小梁切除术治疗原发性开角青光眼(POAG)的远期效果及并发症。设计回顾性队列研究。研究对象非穿透小梁手术患者69例,改良小梁切除手术患者53例。方法对2000年1月-2001年12月间因POAG在中山眼科中心行非穿透小梁手术或改良小梁切除术(小梁切除术联合可拆除缝线、丝裂霉素C)的广东省内患者.于2004年7- 10月以电话或信件方式通知复诊;复诊时详细记录病史、历次复诊和处理情况、当前用药种类,并进行视力、眼压、眼底检查,运用Kaplan-Meier生存分析法比较两种术式的成功率。主要指标眼压、手术成功率及并发症情况。结果83例126眼POAG患者复查,其中非穿透小梁手术57例84眼,改良小梁切除术26例42眼。非穿透小梁手术组、改良小梁切除术组平均年龄分别为(43.7±21.2)岁、(39.6±19.5)岁。平均随访时间42.3±7.9月。非穿透小梁手术组、改良小梁切除术组术前眼压分别为(24.7±8.9) mmHg、(28.9±11.2)mmHg;术前用药种数分别为(1.89±1.1)种、(2.4±0.63)种;术后终点眼压分别为(16.7±6.7)mmHg、(12.2±4.8) mmHg(P=0.000);术后用药种数分别为(0.68±0.9)种、(0.17±0.4)种(P=0.001);完全成功率分别为52.38%、76.2%(P=0.032)。在非穿透小梁手术组中,透明质酸钠凝胶植入物组、生物胶原植入物组完全成功率分别为66.7%、34.6%。结论非穿透小梁手术治疗POAG的远期成功率低于改良式小梁切除术。术中植入人工支撑材料可提高非穿透小梁手术的远期成功率,且透明质酸钠凝胶植入材料比胶原效果好。
Objective To compare the long-term outcome and complications of nonpenetrating trabecular surgery （NPTs） with modified trabeculectomy （Trab） in patients with primary open angle glaucoma.（POAG）. Design Retrospective cohort study. Participants consecutive patients with POAG who lived in Guangdong province and received either NPTs or Trab operation in Zhongshan Ophthalmic center from January 1st in 2000 to December 31st in 2001. Methods All the participants were called back to Zhongshan Ophthalmic Center via letters of invitation or by telephone during the period of July to October in 2004. The detailed information of ocular medical history, follow up time, drugs currently used were recorded. And visual acuity and slit lamp examination, intraocular pressure （IOP） were examed. Kaplan-Meier survival analysis was used to analyze the long-term success rate. Main Outcome Neasures IOP, surgery success rate, postoperative complications. Results 83 patients （126 eyes） with POAG were recruited in this study, including 57 patients （84 eyes） who received non-penetrating deep sclerectomy, with or without implants of collage or hyaluronic acid and MMC, and 26 patients （42 eyes） who had been undergone trabeculeetomy combined with releasable suture and MMC. Mean IOP at the last visit was 16. 7±6.7mmHg in NPTs group, and 12.2±4.8mmHg in Trab group. The difference was statistically significant （P〈0.05）. The complete success rate was 52.38% in NPTs group, while 76.2% in Trab group. Success rate between two cohorts was significantly different （P=0.032）. 0.68±0.9 medications were used in NPTs group at their last visits, and 0.17±0.4 medications in Trab group. In subgroup analysis, the success rates of NPTs combined with SK gel or collagen were 66.7%, 34.6%, respectively. Conclusions Long-term outcome of IOP control with NPTs was inferior to that with modified trabeculectomy. The implantation of SK Gel in NPTs group seems to be superior to implantation of collagen or non-implaut in long-term IOP control.
出处
《眼科》
CAS
2008年第4期278-282,共5页
Ophthalmology in China
