复合式小梁切除加前房注射过滤空气治疗原发性慢性闭角型青光眼

Combined trabeculectomy and injection of filtered air into anterior chamber in the treatment of primary chronic angle closure glaucoma

摘要:

目的：观察复合式小梁切除加前房注射过滤空气治疗原发性慢性闭角型青光眼的临床疗效及手术的安全性和有效性。

方法：将2015-09/2017-06在我院收治的原发性慢性闭角型青光眼患者129例183眼分为注气组和对照组，注气组(68例97眼)行复合式小梁切除加前房注射过滤空气，对照组(61例86眼)行复合式小梁切除术，随访时间3～6(平均4.5)mo，观察术后视力变化、眼压、滤过泡形成、并发症情况，同时记录非计划再次手术情况、住院天数及住院总费用。

结果：注气组术后浅前房、恶性青光眼、非计划再次手术发生率低于对照组，注气组住院天数少于对照组，注气组住院总院费用低于对照组(均P<0.05)。两组不同时间眼压比较，差异有统计学意义(F_组别=42.394，P_组别<0.001； F_时间=7.373，P_时间<0.001； F_交互=23.903，P_交互<0.001)。注气组术后1、3d眼压均高于对照组(P<0.001)，术后7d，3mo两组眼压均无差异(P>0.05)。术后1、3、7d，1mo两组前房闪辉情况均无差异(P>0.05)，术后3mo两组视力变化、滤过泡形成均无差异(P>0.05)。

结论：复合式小梁切除加前房注射过滤空气治疗原发性慢性闭角型青光眼可降低术后浅前房、恶性青光眼及非计划再次手术的发生率，不会加重前房炎症反应，可以安全地保留患者的剩余视功能，同时还可以缩短住院天数及住院总费用，对眼压、视力、滤过泡形成无明显影响。

Abstract:

AIM: To observe the clinical effect of compound trabeculectomy and air filtration injection in the anterior chamber in the treatment of chronic primary angle closure glaucoma, and to evaluate the safety and effectiveness of air filtration injection in the treatment of chronic primary chronic angle closure glaucoma.

METHODS: In a retrospective study, 129 patients(183 eyes)with chronic primary chronic angle closure glaucoma admitted to our hospital from September 2015 to June 2017 were divided into air injection group and control group. Patients in the air injection group(68 cases, 97 eyes)were treated with compound trabeculectomy and air filtration injection into the anterior chamber. Patients in the control group(61 cases, 86 eyes)were treated with compound trabeculectomy. The follow-up time was from 3 to 6mo with an average of 4.5mo.The visual acuity, intraocular pressure, bleb formation and complications were observed, and the unplanned reoperation, length of stay and total cost of stay were recorded.

RESULTS: The incidence of shallow anterior chamber, malignant glaucoma and unplanned reoperation in the air injection group was lower than that in the control group, the days of hospitalization in the air injection group were shorter than that in the control group, and the cost of hospitalization in the air injection group was lower than that in the control group(P<0.05). There was significant difference in intraocular pressure between different groups(F_group=42.394, P_group<0.001; F_time=7.373, P_time<0.001; F_time×group=23.903, P_time×group<0.001). Intraocular pressure at different time points was compared between groups. There was significant difference(P<0.001)in intraocular pressure of 1, 3d and no significant difference(P>0.05)in 3, 7d between the two groups. There was no significant difference(P>0.05)in the flash of anterior chamber of 1, 3, 7d and 1mo between the two groups. There was no significant difference(P>0.05)in the changes of vision and the formation of filtering blebs between the two groups in 3mo(P>0.05).

CONCLUSION:Combined trabeculectomy and air filtration in the anterior chamber for chronic primary angle closure glaucoma can reduce the incidence of shallow anterior chamber, malignant glaucoma and unplanned reoperation, not aggravate the inflammatory reaction in the anterior chamber, safely retain the residual visual function of patients, shorten the length of stay in hospital and the total cost of hospitalization, and have no effect on the formation of intraocular pressure, vision and filtering bleb obvious influence.