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目的探讨缝线植入Schlemm管开口部成形联合小梁切除术治疗原发性开角型青光眼的有效性和安全性。设计同顾性、非对照病例系列。研究对象 11例(19眼)原发性开角型青光眼患者。方法做二层巩膜瓣并切除深层巩膜瓣,剪除 Schlemm管外壁,将6-0尼龙线从管断端口分别植入Schlemm管内,穿透性小梁切除及相应虹膜剪除,水密缝合浅层巩膜瓣。主要指标眼压、前房、视力、手术并发症及滤过泡。结果术后随访6-48个月,平均(18．05±12．78)个月。术后末次随访平均眼压 (15．11±6．13)mmHg,与术前平均眼压(31．23±9．72)mmHg比较,差异有统计学意义(t=6．769,P=0．000)。术后经局部降眼压药物治疗眼压≥22mmHg者仅1例1眼,成功率达94．74％。术后形成滤过泡6例8眼(42．11％),其中1眼为眼压≥22mmHg者。术后有滤过泡者与无滤过泡者的术前、术后末次随访平均眼压比较差异无统计学意义(t=-1．662,P=0 071)。术后均无前房形成迟缓。4 眼(21．05％)术后出现前房积血。一过性眼压升高3眼(15．78％)。一过性低眼压11眼(57．89％)。术后均无前房内纤维蛋白渗出、脉络膜脱离等并发症。结论缝线植入Schlemm管开口部成形联合小梁切除术治疗原发性开角型青光眼降眼压效果肯定,术后并发症少,术后管理容易,为一种具有探讨价值的抗青光眼新手术。
Objective To investigate the effectiveness and safety of suture implantation in Schlemm’s canal opening combined with trabeculectomy in the treatment of primary open-angle glaucoma. Design with the same type of non-control cases. Eleven patients (19 eyes) had primary open angle glaucoma. Methods The scleral flap was made and the deep scleral flap was excised. The outer wall of Schlemm’s tube was excised. The 6-0 nylon thread was implanted into the Schlemm’s canal separately from the cannulated port. The penetrating trabeculectomy was performed and the corresponding iris was excised. The superficial scleral flap . The main indicators of intraocular pressure, anterior chamber, visual acuity, surgical complications and filtration bleb. Results The patients were followed up for 6-48 months, with an average of (18.05 ± 12.78) months. The mean intraocular pressure (15.11 ± 6.13) mmHg after the last follow-up was significantly different from the preoperative mean intraocular pressure (31.23 ± 9.72) mmHg (t = 6.769, P = 0.000). Postoperative local intraocular pressure medication for intraocular pressure ≥ 22mmHg were only 1 case 1, the success rate of 94.74%. Postoperative filtration bleb formation in 6 cases 8 eyes (42.11%), of which 1 eye pressure ≥ 22mmHg were. There was no significant difference in mean intraocular pressure at the last follow-up after operation between those with and without filtration (t = -1.662, P = 0 071). No anterior chamber formation after the onset of retardation. Four eyes (21.05%) had hyphema after operation. A transient increase in intraocular pressure in 3 eyes (15.78%). A transient low intraocular pressure in 11 eyes (57.89%). No anterior chamber fibrin exudation, choroidal detachment and other complications. Conclusion Suture implantation Schlemm’s canal opening combined with trabeculectomy for the treatment of primary open-angle glaucoma IOP has a positive effect, less postoperative complications, postoperative management is easy, as a valuable anti-glaucoma surgery.