Mori Kazuhiko, Ikeda Yoko, Maruyama Yuko, Naruse Shigeta, Ueno Morio, Kinoshita Shigeru
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Int Med Case Rep J. 2016 Jan 25;9:9-14. doi: 10.2147/IMCRJ.S96306. eCollection 2016.
To report the cases of six consecutive patients who underwent amniotic membrane (AM)-assisted trabeculectomy (TLE) to treat refractory glaucoma with severe corneal disorders.
This study involved six patients (three males and three females, mean age: 69.5±15.8 years) with refractory glaucoma and severe corneal disorders. The surgical procedure for each patient involved trabecular tissue being excised, and human AM then being placed epithelial side up on the corneal surface, sutured at the limbal sclera, and flipped over onto the sclera to cover the TLE area. The remaining edge of the AM was then inserted into the subconjunctival space and sutured. Medical records of all cases were reviewed with regard to intraocular pressure (IOP), visual acuity, and condition of the filtering bleb and ocular surface.
The mean observation period was 69.5±15.8 months, and mean IOP at presurgery and at 1, 3, and 7 years postoperative was 40.3±6.9, 23.0±12.1, 25.6±12.8, and 28.5±19.1 mmHg, respectively. Glaucoma medications decreased from 3.0±1.1 drugs (presurgery) to 0.8±1.0 drugs (7 years postoperative). However, in some cases, ocular surface conditions or visual acuity worsened during the follow-up period.
Using AM as an internal patch for TLE, moderately good IOP control was obtained initially for the refractory glaucoma with severe corneal disorders; however, ocular surface conditions required special care, and the long-term IOP control was limited in some cases.
报告连续6例接受羊膜辅助小梁切除术治疗伴有严重角膜病变的难治性青光眼患者的病例。
本研究纳入6例（3例男性，3例女性，平均年龄：69.5±15.8岁）伴有严重角膜病变的难治性青光眼患者。每位患者的手术过程包括切除小梁组织，然后将人羊膜上皮面朝上放置在角膜表面，在角巩膜缘处缝合，再翻转到巩膜上以覆盖小梁切除区域。然后将羊膜的剩余边缘插入结膜下间隙并缝合。回顾了所有病例的病历，包括眼压、视力、滤过泡和眼表情况。
平均观察期为69.5±15.8个月，术前及术后1年、3年和7年的平均眼压分别为40.3±6.9、23.0±12.1、25.6±12.8和28.5±19.1 mmHg。青光眼用药从术前的3.0±1.1种药物减少到术后7年的0.8±1.0种药物。然而，在某些病例中，随访期间眼表情况或视力恶化。
使用羊膜作为小梁切除术的内部补片，对于伴有严重角膜病变的难治性青光眼，最初眼压控制效果尚可；然而，眼表情况需要特别护理，且在某些病例中，长期眼压控制有限。
