CAJ | 학술논문

目的通过减少手术创面,探讨微创小梁切除联合生物羊膜移植术治疗青光眼的临床价值.方法在小梁切除联合羊膜移植术中,64只青光眼被随机分入2组,微创组32只眼,制作4 mm×4 mm结膜瓣和2.5 mm×2.5 mm巩膜瓣,切除1 mm×1.5 mm小梁组织.常规组32只眼,使用常规手术方法即8 mm×8 mm结膜瓣、4 mm×4 mm巩膜瓣,切除小梁组织1.5 mm×3 mm.术后观察眼压、色素膜、滤过泡、角膜内皮的变化,平均随访8个月.结果 (1)微创组和常规组术后1年的平均眼压分别为(17.36±4.25)和(15.41±6.21) mmHg,两组对比差异无统计学意义(P＞0.05).(2)两组术后早期均形成明显弥散滤过泡,12个月后有功能滤过泡者微创组占78.12％ (25/32),常规组占62.5％(20/32),差异无统计学意义(P＞0.05).(3)术后早期常规组色素膜反应比微创组重,且浅前房或伴发脉络膜脱离发生率较多.两组差异有统计学意义(P＜0.05).(4)术后12个月微创组和常规组内皮平均丢失率为9.6％ (180.5/1880)和16.3％ (306.4/1880),两组差异有统计学意义(P＜0.01).结论微创小梁切除术联合羊膜移植治疗青光眼,手术创伤小、术后色素膜反应轻、内皮损失少,疗效良好.
목적 통과감소수술창면,탐토미창소량절제연합생물양막이식술치료청광안적림상개치.방법 재소량절제연합양막이식술중,64지청광안피수궤분입2조,미창조32지안,제작4 mm×4 mm결막판화2.5 mm×2.5 mm공막판,절제1 mm×1.5 mm소량조직.상규조32지안,사용상규수술방법즉8 mm×8 mm결막판、4 mm×4 mm공막판,절제소량조직1.5 mm×3 mm.술후관찰안압、색소막、려과포、각막내피적변화,평균수방8개월.결과 (1)미창조화상규조술후1년적평균안압분별위(17.36±4.25)화(15.41±6.21) mmHg,량조대비차이무통계학의의(P＞0.05).(2)량조술후조기균형성명현미산려과포,12개월후유공능려과포자미창조점78.12％ (25/32),상규조점62.5％(20/32),차이무통계학의의(P＞0.05).(3)술후조기상규조색소막반응비미창조중,차천전방혹반발맥락막탈리발생솔교다.량조차이유통계학의의(P＜0.05).(4)술후12개월미창조화상규조내피평균주실솔위9.6％ (180.5/1880)화16.3％ (306.4/1880),량조차이유통계학의의(P＜0.01).결론 미창소량절제술연합양막이식치료청광안,수술창상소、술후색소막반응경、내피손실소,료효량호.
Objective To explore the clinical value of micro-invasive trabeculectomy combined with biological amniotic membrane implantation through reducing the surgically traumatic area.Methods In the surgeries of trabeculectomy combined with biological amniotic membrane implantation,64 eyes with glaucoma were divided randomly into 2 treatment groups.In the group of micro-invasive trabeculectomy was given to 32 eyes by making conjunctival flap measuring 4×4mm,scleral flap measuring 2.5 ×2.5mm,and resecting the trabecular meshwork measuring 1 × 1.5mm.In the group of conventional trabeculectomy was given to 32 eyes by making conjunctival flap measuring 8×8mm,scleral flap measuring 4×4mm,and resecting the trabecular meshwork measuring 1.5× 3mm.After the surgery,the changes of the intraocular pressure (IOP),the uvea,the filtering bleb and the corneal endothelium were observed and recorded.And the average follow-up duration was 12 months.Results At 12 months post-surgery,the IOP in the micro-invasive group and the conventional group were (17.36±4.25) and (15.41±6.21)mmHg,respectively.There was no significant difference between these 2 groups (P ＞0.05).There were obvious diffusing filtering blebs at the early stage post-surgery in these 2 groups.After 12 months,78.12％ (25/32) eyes of the micro-invasive group still had functional filtering blebs,while 62.5％ (20/32) eyes of the conventional group.There was no significant difference between these 2 groups (P ＞0.05).The micro-invasive group had milder uveal reaction at the early stage post-surgery than the conventional group.And the incidence of shallow anterior chamber or concomitant with choroidal detachment was higher in the conventional group,there was obvious difference between these 2 groups (P ＜0.05).At 12 months post-surgery,the loss rate of the corneal endothelium of the conventional group was 16.3％ (306.4/1880),while 9.6％ (180.5/1880) on the micro-invasive group.And there was obvious difference between these 2 groups (u =2.813,P ＜0.01).Conclusions The micro-invasive trabeculectomy combined with biological amniotic membrane implantation has good clinical effect with less operational trauma,less uveal reaction and less loss of the corneal endothelium.