原发性闭角型青光眼小梁切除术中两种巩膜瓣可调整缝线的疗效比较

吴佐全

[關键词] 小梁切除术;可调整缝线;原发性闭角型青光眼;巩膜瓣

[中图分类号] R775.2          [文献标识码] B          [文章编号] 1673-9701（2021）29-0092-04

Comparison of efficacy of two scleral flap adjustable sutures in primary angle-closure glaucoma trabeculectomy

WU Zuoquan

Department of Ophthalmology， Sanming First Hospital Affiliated to Fujian Medical University， Sanming   365000， China

[Abstract] Objective To investigate the clinical efficacy of two scleral flap adjustable sutures in primary angle-closure glaucoma trabeculectomy. Methods A total of 43 patients（60 eyes） with primary angle-closure glaucoma treated in the Department of Ophthalmology of the Sanming First Hospital from January 2018 to June 2020 were selected. They were randomly divided into the control group and the observation group， with 30 eyes in each group. The control group were treated with trabeculectomy combined with 1 pair of adjustable sutures on both sides of the scleral flap，and the observation group were treated with trabeculectomy combined with 1 pair of adjustable sutures on the nasal posterior corner and middle of the scleral flap. Both groups were followed up regularly for 3 months to compare the incidence of complications，postoperative intraocular pressure control and success rate of surgery. Results There was no significant difference in the total incidences of complications of shallow anterior chamber and choroidal detachment in the two groups after surgery（P>0.05）. 1 day，1 month and 3 months after surgery，the intraocular pressures of the observation group were lower than those of the control group， with statistically significant differences（P<0.05）.7 day and 2 weeks after surgery， the intraocular pressures in the observation group were lower than those in the control group，but without statistically significant differences （P>0.05）.3 months after surgery， the success rate in the observation group was 96.67%（29/30），which was higher than that of 73.33%（22/30） in the control group，with statistically significant difference（P<0.05）. Conclusion The combined use of modified scleral flap adjustable suture technique in primary angle-closure glaucoma trabeculectomy is safe and effective. Compared with the traditional scleral flap adjustable suture，it improves the success rate of surgery at 3 months after surgery.

[Key words] Trabeculectomy; Adjustable suture; Primary angle-closure glaucoma; Scleral flap

青光眼是一种危害性大、全球第二位致盲的常见眼病，病理性眼压增高是其主要危险因素。在中国原发性闭角型青光眼是临床上主要青光眼类型之一[1-2]，小梁切除术是临床已广泛应用的主要手术方式，其通过切除的小梁使房水向外引流而降低眼内压。小梁切除术治疗闭角型青光眼较易发生浅前房、低眼压、脉络膜脱离及高眼压等早期术后并发症[3-4]。青光眼小梁切除术中可调整缝线的应用是于1971年由Schaffer 提出[5]，可以大大减少因滤过量过多或过少导致的各种手术并发症[6-8]，而且可调整缝线不需特殊设备，经济简单，所以在青光眼小梁切除术中得到了广泛的应用[8]。现就小梁切除术采用两种不同巩膜瓣可调整缝线技术在原发性闭角型青光眼中的临床疗效和并发症进行研究分析，现报道如下。

1 资料与方法

1.1一般资料

选取2018年1月至2020年6月我院眼科收治并随访的原发性闭角型青光眼患者43例（60眼），其中急性闭角型青光眼 38眼，慢性闭角型青光眼22眼，男14例，女29例，年龄46～71 岁，平均（56.4±7.3）岁;将其随机分为观察组和对照组，每组各30眼。纳入标准[9]：①经裂隙灯显微镜、眼压计、前房角镜、视野、超声生物显微镜、光学相干断层扫描、眼底镜等检查确诊的原发性闭角型青光眼;②眼压>25 mmHg;③视乳头杯/盘比值≥0.7或双眼视乳头杯/盘比差值≥0.2;④合并有青光眼性视野损害;⑤前房角关闭粘连超过6个钟点位;⑥眼轴≥21 mm。……