方法：采用随机对照方法，将48例48眼 PACG患者平均分为两组：试验组和对照组，试验组行“W”形切口延迟性可调整缝线小梁切除术，对照组行常规复合小梁切除手术，随访3～6mo，对比观察两组间视力、眼压、屈光状态、OSDI、泪膜四项和滤过泡、手术成功率及术后并发症等。

结果：术前两组散光值、OSDI、泪膜四项差异无统计学意义(t_散光=0.764，t_OSDI =0.652，t_BUT=-1.837， t_泪河高度=-1.535， t_ST =-1.821， t_FL =1.916，P 均>0.05)，试验组术后1wk， OSDI，BUT，ST，泪河高度及FL均与未发病眼相似，差异无显著性(t_AOSDI =1.052，t_ABUT=0.974， t_{A泪河高度}=0.998， t_AST =-1.225， t_AFL =0.784，P均>0.05)； 对照组术后1wk， OSDI，BUT，ST，泪河高度及FL与未发病眼相比，差异有显著性(t_BOSDI =14.538，t_BBUT=5.241， t_{B泪河高度}=2.694，t_BST=-3.189， t_BFL=-1.355，P均<0.05)，两组术后2wk，OSDI，BUT，ST，泪河高度及FL均与未发病眼相似，差异无显著性(t_AOSDI =0.828，t_ABUT=0.537， t_{A泪河高度}=0.662， t_AST=-0.691， t_AFL=0.046； t_BOSDI =0.774，t_BBUT=1.082， t_{B泪河高度}=0.629， t_BST=-0.558， t_BFL =-0.719，P均>0.05)。两组术后3mo试验组与对照组在眼压、视力、功能性滤过泡的累积存活率、手术成功率差异无显著性(t_眼压=0.292， P均>0.05； χ²_视力=1.928， χ²_{累积完全成功率}=2.669， χ²_{条件成功率}=2.198， P均>0. 05)，而形成的术源性散光，滤过泡差异有显著性(t_散光=9.964，χ²_滤过泡=9.662，P均<0.05)。

结论：个性化“W”形切口延迟性可调整缝线小梁切除术可以减少PACG患者术后散光并可以较早稳定泪膜、减轻眼表症状，提高患者的视觉质量。

METHODS: In a prospective randomized sample controlled clinical study, 48 patients(48 eyes)were randomly divided into two groups:(group A)trabeculectomy with incision of “W” form and adjustment suture;(group B)traditional compound trabeculectomy surgery. The vision, intraocular pressure, astigmatism, ocular surface disease index(OSDI), tear film function, filtering bleb, success rate of operation and postoperative complications were performed at 1 week, 3 months and 6 months postoperatively.

RESULTS:There were no significant difference for corneal astigmatism, OSDI and tear film function between two groups preoperatively( t_astigmatism=0.764,t_OSDI=0.652,t_{break up time} =-1.837, t_{tear river altitude} =-1.535, t_ST=-1.821, t_FL=1.916,P>0.05). There were no statistically significance for OSDI, break up time(BUT), Schirmer test(ST), tear river altitude and fluorescein staining(FL)at 1 week post-operation in group A compared with the fellow eyes(t_AOSDI =1.052, t_ABUT=0.974, t_{Atear river altitude} =0.998, t_AST =-1.225, t_AFL =0.784, P>0.05), whereas statistically significance at 1 week post-operation in group B compared with the fellow eyes(t_BOSDI =14.538,t_BBUT=5.241, t_{Btear river altitude} =2.694, t_BST =-3.189, t_BFL =-1.355,P<0.05). There were no statistically significance for symptom eyes, OSDI, BUT and FL at 2 weeks post-operation in both groups compared with the fellow eyes(t_AOSDI =0.828,t_ABUT=0.537, t_{Atear river altitude} =0.662, t_AST = -0.691, t_AFL =0.046; t_BOSDI =0.774,t_BBUT=1.082, t_{B tear river altitude}=0.629, t_BST =-0.558, t_BFL =-0.719, P>0.05). There were statistically significance for surgically induced astigmatism, filtering bleb in both groups(t _astigmatism=9.964, χ² _{filtering bleb}=9.662,P<0.05), whereas no statistically significance on vision, intraocular pressure, cumulative survival rate of functional filter blebs and success rate of operation in both groups(P>0.05).

CONCLUSIONS: Trabeculectomy with incision of “W” form and adjustment suture is a more favorable solution for primary angle-closure glaucoma patients, which can stabilize the tear film,mitigate the symptom of ocular surface and corneal astigmatism, and therefore improve the visual quality.