丝裂霉素C“巩膜直隧道切口”——可松解缝线小梁切除术

Wang Lin-nong, Fang Fang, Zhang Yang, Chen Li-xun, Zhao Tai-hong, Xiao Lei, Tang Hong

Ophthalmic Center, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006.

Chin Med Sci J. 2006 Sep;21(3):157-62.

OBJECTIVE

To evaluate the efficacy of "straight scleral tunnel incision" -trabeculectomy with a releasable suture supplemented with mitomycin C (MMC) on reducing intraocular pressure (IOP), complications, and corneal astigmatism in patients with primary angle-closure glaucoma (PACG).

METHODS

Totally 217 acute or chronic PACG patients with occludable angle above 180 degrees and IOP above 21 mm Hg were divided into 3 groups. Patients in group A (98 cases, 128 eyes), B (71 cases, 95 eyes), and C (48 cases, 60 eyes) were treated with "straight scleral tunnel incision"-trabeculectomy with a releasable suture supplemented with MMC, releasable suture trabeculectomy with MMC, and trabeculectomy with MMC, respectively. IOP, complications, and surgically induced astigmatism (SIA) were evaluated preoperatively and up to 12 months postoperatively.

RESULTS

IOP of 2 weeks after treatment was significantly lower than preoperative IOP in all the 3 groups (all P <0. 001). Success rates (IOP < or = 20 mm Hg) in group A, B, and C were 87.91%, 89.23%, and 83.72% respectively at 12 months after treatment (P = 0.256). The incidence of shallow anterior chamber and hypotony had no significant difference between group A and B, but both of them were lower than that in group C (P < 0.05). There were no significant differences in preoperative corneal astigmatism among the 3 groups. The corneal astigmatism after 2 weeks in group A (1.71 +/- 1.47D) was higher than that before operation (1.28 +/- 1.05D, P = 0.126). With 12 months gone, the astigmatism almost returned to preoperative levels. The corneal astigmatisms after 2 weeks in group B and C (1.99 +/- 1.20D and 2. 22 +/- 1.39D) were significantly higher than those before operation (1.20 +/- 0.85D and 1.18 +/- 0.93D, P = 0.002, P = 0.001), respectively. With 12 months gone, the mean astigmatisms in group B and C (1.87 +/- 0.91D and 1.90 +/- 1.16D) were still significantly higher than those before operation (P = 0.001, P = 0.003). The highest astigmatic polar values in group A, B, and C (1.00D, 1. 89D, and 1. 77D) occurred after 2 weeks, 1 month, and 1 month postoperation, respectively, which were significantly higher than those before operation (0.19 +/- 1.32D, 0.12 +/- 1.22D, and 0.17 +/- 1.25D, P < 0.01), respectively. With 12 months gone, they were 0. 03D, -0. 18D, and -0. 13D higher than those before operation, respectively. The rates of function bleb and thin-wall bleb were 71.43% and 26.37% in group A, 75.38% and 29.23% in group B, 72.09% and 25.58% in group C, respectively at 12 months after treatment There were no significant differences among the 3 groups.

CONCLUSION

"Straight scleral tunnel incision" -trabeculectomy with a releasable suture supplemented with MMC can reduce complications and get satisfactory results in reducing IOP and SIA.

目的

评估“直巩膜隧道切口”小梁切除术联合可拆除缝线并补充丝裂霉素C（MMC）治疗原发性闭角型青光眼（PACG）患者降低眼压（IOP）、并发症及角膜散光的疗效。

方法

将217例急性或慢性PACG患者，其房角关闭超过180度且眼压高于21 mmHg，分为3组。A组（98例，128眼）、B组（71例，95眼）和C组（48例，60眼）患者分别接受“直巩膜隧道切口”小梁切除术联合可拆除缝线并补充MMC、可拆除缝线小梁切除术联合MMC以及小梁切除术联合MMC治疗。术前及术后12个月评估眼压、并发症及手术诱导散光（SIA）。

结果

治疗后2周，3组患者的眼压均显著低于术前（均P <0.001）。治疗后12个月，A组、B组和C组的成功率（眼压≤20 mmHg）分别为87.91%、89.23%和83.72%（P = 0.256）。A组和B组浅前房和低眼压的发生率无显著差异，但均低于C组（P <0.05）。3组术前角膜散光无显著差异。A组术后2周角膜散光（1.71±1.47D）高于术前（1.28±1.05D，P = 0.126）。术后12个月，散光几乎恢复到术前水平。B组和C组术后2周角膜散光（1.99±1.20D和2.22±1.39D）显著高于术前（1.20±0.85D和1.18±0.93D，P = 0.002，P = 0.001）。术后12个月，B组和C组的平均散光（1.87±0.91D和1.90±1.16D）仍显著高于术前（P = 0.001，P = 0.003）。A组、B组和C组术后最高散光极差值（1.00D、1.89D和1.77D）分别出现在术后2周、1个月和1个月，均显著高于术前（0.19±1.32D、0.12±1.22D和0.17±1.25D，P <0.01）。术后12个月，它们分别比术前高0.03D、-0.18D和-0.13D。治疗后12个月，A组、B组和C组功能性滤过泡率分别为71.43%、75.38%和72.09%，薄壁滤过泡率分别为26.37%、29.23%和25.58%，3组间无显著差异。