摘要
目的:评价个性化"W"形切口延迟性可调整缝线小梁切除术在原发性闭角型青光眼(primarily angle-closureglaucoma,PACG)的临床效果。方法:采用随机对照方法,将48例48眼PACG患者平均分为两组:试验组和对照组,试验组行"W"形切口延迟性可调整缝线小梁切除术,对照组行常规复合小梁切除手术,随访3～6mo,对比观察两组间视力、眼压、屈光状态、OSDI、泪膜四项和滤过泡、手术成功率及术后并发症等。结果:术前两组散光值、OSDI、泪膜四项差异无统计学意义(t散光=0.764,tOSDI=0.652,tBUT=-1.837,t泪河高度=-1.535,tST=-1.821,tFL=1.916,P均>0.05),试验组术后1wk,OSDI,BUT,ST,泪河高度及FL均与未发病眼相似,差异无显著性(tA OSDI=1.052,tABUT=0.974,tA泪河高度=0.998,tAST=-1.225,tAFL=0.784,P均>0.05);对照组术后1wk,OSDI,BUT,ST,泪河高度及FL与未发病眼相比,差异有显著性(tB OSDI=14.538,tBBUT=5.241,tB泪河高度=2.694,tBST=-3.189,tBFL=-1.355,P均<0.05),两组术后2wk,OSDI,BUT,ST,泪河高度及FL均与未发病眼相似,差异无显著性(tA OSDI=0.828,tABUT=0.537,tA泪河高度=0.662,tA ST=-0.691,tAFL=0.046;tB OSDI=0.774,tBBUT=1.082,tB泪河高度=0.629,tBST=-0.558,tBFL=-0.719,P均>0.05)。两组术后3mo试验组与对照组在眼压、视力、功能性滤过泡的累积存活率、手术成功率差异无显著性(t眼压=0.292,P均>0.05;χ2视力=1.928,χ2累积完全成功率=2.669,χ2条件成功率=2.198,P均>0.05),而形成的术源性散光,滤过泡差异有显著性(t散光=9.964,χ2滤过泡=9.662,P均<0.05)。结论:个性化"W"形切口延迟性可调整缝线小梁切除术可以减少PACG患者术后散光并可以较早稳定泪膜、减轻眼表症状,提高患者的视觉质量。
AIM： To observe the clinical effects of trabeculectomy with incision of “W” form and adjustment suture for primary angle-closure glaucoma（PACG）.METHODS： In a prospective randomized sample controlled clinical study, 48 patients（48 eyes）were randomly divided into two groups：（group A）trabeculectomy with incision of “W” form and adjustment suture;（group B）traditional compound trabeculectomy surgery. The vision, intraocular pressure, astigmatism, ocular surface disease index（OSDI）, tear film function, filtering bleb, success rate of operation and postoperative complications were performed at 1 week, 3 months and 6 months postoperatively. RESULTS：There were no significant difference for corneal astigmatism, OSDI and tear film function between two groups preoperatively（ tastigmatism=0.764,tOSDI=0.652,tbreak up time =-1.837, ttear river altitude =-1.535, tST=-1.821, tFL=1.916,P〉0.05）. There were no statistically significance for OSDI, break up time（BUT）, Schirmer test（ST）, tear river altitude and fluorescein staining（FL）at 1 week post-operation in group A compared with the fellow eyes（tAOSDI =1.052, tABUT=0.974, tAtear river altitude =0.998, tAST =-1.225, tAFL =0.784, P〉0.05）, whereas statistically significance at 1 week post-operation in group B compared with the fellow eyes（tBOSDI =14.538,tBBUT=5.241, tBtear river altitude =2.694, tBST =-3.189, tBFL =-1.355,P〈0.05）. There were no statistically significance for symptom eyes, OSDI, BUT and FL at 2 weeks post-operation in both groups compared with the fellow eyes（tAOSDI =0.828,tABUT=0.537, tAtear river altitude =0.662, tAST = -0.691, tAFL =0.046; tBOSDI =0.774,tBBUT=1.082, tB tear river altitude=0.629, tBST =-0.558, tBFL =-0.719, P〉0.05）. There were statistically significance for surgically induced astigmatism, filtering bleb in both groups（t astigmatism=9.964, χ2 filtering bleb=9.662,P〈0.05）, whereas no statistically significance on vision, intraocular pressure, cumulative survival rate of functional filter blebs and success rate of operation in both groups（P〉0.05）.CONCLUSIONS： Trabeculectomy with incision of “W” form and adjustment suture is a more favorable solution for primary angle-closure glaucoma patients, which can stabilize the tear film,mitigate the symptom of ocular surface and corneal astigmatism, and therefore improve the visual quality.
出处
《国际眼科杂志》
CAS
2012年第10期1859-1862,共4页
International Eye Science
基金
国家自然科学基金资助项目(No.81160118
81101858
81100648
81100649)
江西省自然科学基金(No.20114BAB215029)
江西省科技支撑计划项目(No.20111BBG70026-2)
江西省卫生厅科技计划面上项目(No.20121026)
江西省教育厅青年科学基金项目(No.JJJ12158)~~
