摘要
目的应用超声生物显微镜（UBM）观察原发性慢性闭角型青光眼（PCACG）患者复合式小梁切除联合HEMA青光眼引流器植入术后滤过泡的形态，评价其手术效果。方法前瞻性队列研究。采用随机数字表法，将60例（60眼）PCACG患者，随机分为研究组和对照组各30例（30眼），研究组行复合式小梁切除联合HEMA青光眼引流器植入术，对照组行复合式小梁切除术。术前1d、术后3个月、术后6个月均进行最佳矫正视力（BCVA，结果转化为logMAR视力用于统计）和Goldman压平眼压（IOP）检查。术后3个月、6个月均进行了UBM检查。数据采用独立样本t检验、重复测量方差分析、Fisher确切概率法进行分析。结果对照组术前1d、术后3个月、术后6个月的BCVA分别为0．63±0．48、0．54±0．35和0．55±0．34。研究组分别为0．66±0．56、0．49±0．25和0．50±0．27．2组间3个时间点BCVA差异均无统计学意义（P〉0．05）。2组各时间点间BCVA的差异也无统计学意义（P〉O．05）。对照组3个时间点IOP分别为（19．2±12．2）mmHg、（16．3±4．5）mmHg和（16．8±4．6）mmHg（1mmHg=0．133kPa），研究组分别为（18．7±10．2）mmHg、（12．4±4．1）mmHg和（12．9±3．7）mmHg，2组间术前1d的IOP差异无统计学意义（P〉0．05），术后3、6个月2组间差异有统计学意义（t=-3．480、-3．628，P〈0．01）。对照组各时间点间IOP的差异无统计学意义（P〈0．05），研究组各时间点间差异有统计学意义（F=10．435，P〈0．05），术后3个月和6个月均明显低于术前。术后3个月时对照组L型滤过泡形成率为97％，研究组为100％，2组间L型滤过泡形成率的差异无统计学意义；术后6个月时，对照组L型滤过泡形成率为77％，研究组为97％，组间差异有统计学意义（X2=-5．192，P〈0．05）。结论复合式小梁切除联合国产HEMA青光眼引流器植入术较复合式小梁切除术降眼压效果好，术后功能性滤过泡形成率高，手术成功率更高。
Objective Observe filtering bleb after compound trabeculectomy combined HEMA glaucoma shunting device implantation operation in primary chronic angle-closure glaucoma （PCACG） patients using ultrasound biomicroscopy （UBM）. Methods This was a prospective cohort study. Sixty eyes of 60 subjects with PCACG were randomly devided into the research group （30 cases） and the control group （30 cases）. The control group received compound trabeculectomy, and the research group received compound trabeculectomy combined with HEMA glaucoma shunting device implantation. The best corrected visual acuity （BCVA） and the intraocular pressure （IOP） were measured 1 day preoperation, and 3 months and 6 months postoperation. Filtering bleb morphology were observed at 3 months and 6 months postoperation using UBM. Data were analyzed using independent t test, repeated measured ANOVA, Fisher exact test. Results The BVCA （logMAR） of the control group were 0.63±0.48, 0.54±0.35 and 0.55±0.34, while were 0.66±0.56, 0.49±0.25 and 0.50±0.27 in the treatment group. The differences were not significant between groups and time points （P〉0.05）. The IOP ofthe control group was 19.2＋12.2 mmHg, 16.3±4.5 mmHg and 16.8±4.6 mmHg （1 mmHg=0.133 kPa）, respectively, while were 18.7±10.2 mmHg, 12.4±4.1 mmHg and 12.9±3.7 mmHg in the the treatment group. There was no significant difference between the two groups at 1 day preoperation （P〉0.05） but with significant diffrenees at 3 months and 6 months postoperation （t=-3.480, -3.628, P〈0.01）. There were without significant differences among the three time points in the the control group （P〉0.05）, but with significant differences in the research group （F=10.435, P〈0.05）. At 3 months postoperatively, There was 97% type L （low-reflective） bleb in the control group while 100% in the research group, the difference was not significant （P〉0.05）. At 6 months after surgery, There was 77% type L bleb in the control group while 97% in the research group, the differences were significant between the two groups （X2=5.192, P〈0.05）. Conclusion Compound trabeculectomy combined with HEMA glaucoma shunting device implantation is effective to reduce IOP, and easy to form functional filtering bleb, surgical success rate higher.
出处
《中华眼视光学与视觉科学杂志》
CAS
CSCD
2016年第11期689-693,695,共6页
Chinese Journal Of Optometry Ophthalmology And Visual Science
基金
绍兴市科技计划重点项目（2011A23028）
