巩膜瓣下纵形巩膜条形切除联合黏弹剂在复合式小梁切除术中的应用

Application of Longitudinal Sclerectomy under Scleral Flap, Viscoelastic Agent, Adjustable Suture and MMC on the Trabeculectomy

摘要: 目的：探讨在青光眼小梁切除手术中应用巩膜瓣下纵形巩膜条形切除、黏弹剂、可调整缝线及丝裂霉素C的临床疗效，寻求提高青光眼手术疗效的途径。方法：将105例120眼原发性闭角型青光眼患者随机分为二组，实验组(改良式小梁切除术组) 61眼行小梁切除术，术中应用巩膜瓣下纵形巩膜条形切除、黏弹剂、可调整缝线及丝裂霉素C；对照组59眼行常规小梁切除术。术后进行6个月~24月的随访，观察手术前后的视力、视野、眼压、前房深度和术后滤过泡形态及并发症的情况。结果：术后有2例患者失访，最终实验组60眼，对照组58眼纳入结果分析。实验组所有病例术前术后视力不变或增减1行，视野基本不变。实验组术后3天随访眼压平均为(18.5 ± 3.3) mmHg，术后6个月随访眼压平均为(12.7 ± 3.2) mmHg，眼压正常占95.00%；对照组术后3天随访眼压平均为(13.5 ± 3.1) mmHg，术后6个月随访眼压平均为(15.9 ± 3.4) mmHg，眼压正常占81.03%。实验组功能性滤过泡占95.00%；对照组功能性滤过泡占82.76%。实验组的眼压控制率、功能性滤过泡比例均较对照组高(P < 0.05)。浅前房的发生率(13.33%)比对照组(31.03%)低，差异有统计学意义(P < 0.05)；实验组脉络膜脱离及前房出血等并发症的发生率(1.67%, 1.67%)比对照组(13.79%, 15.52%)低，差异有统计学意义(P < 0.05)。结论：青光眼小梁切除手术中应用巩膜瓣下纵形巩膜条形切除、黏弹剂、可调整缝线及丝裂霉素C，可有效地降低眼压，减少手术并发症的发生，提高手术成功率。

Abstract: Objective: To explore the effect of application of longitudinal sclerectomy under scleral flap, viscoelastic agent, adjustable suture and mitomycin C (MMC) on the trabeculectomy in the pa-tients with primary angle-cloure glaucoma (PACG). Methods: 105 cases (120 eyes) with PACG were divided into two groups randomly. The longitudinal sclerectomy under scleral flap, visco-elastic agent, adjustable suture and MMC were used on the trabeculectomy in the experimental group of 61 eyes; the control group was without longitudinal sclerectomy under scleral flap, viscoelastic agen and adjustable suture. The patients were followed-up for 6 months to 2 year and the IOP, anterior chamber, filtering bleb and complications at pre-operation and post-operation were observed. Results: After operation, two patients were not followed-up, and finally, the 60 eyes in the experimental group were analysed. The shallow anterior chamber in the experimental group was 13.33% and that in the control group was 31.03% (P < 0.05). The average IOP in the experimental group was (18.5 ± 3.3) mmHg during the 3rd day after opera-tion, (12.7 ± 3.2) mmHg after 6 months; that in the control group was (13.5 ± 3.1), (15.9 ± 3.4) mmHg. The visual acuity of the patients in the experimental group kept unchanged before and after the operation or improved or decreased slightly. The functional follicle type I + II in the experimental group was 95.00%; the control group was 82.76% (P < 0.05). The complication of hyphema, choroidal detachment in the experimental group was 1.67%, 1.67%; the control group was 13.79%, 15.52% (P < 0.05). Conclusion: The longitudinal sclerectomy under scleral flap, viscoelastic agent, adjustable suture and MMC on trabeculectomy can be safely applied and the complications obviously are decreased.