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目的评价超声乳化白内障吸除折叠式人工晶状体(IOL)植入联合非穿透性小梁手术并滤过道内植入羊膜组织(N-P术)的临床效果。方法对29例35眼因白内障合并原发性开角型青光眼患者行N-P术治疗,总结和分析患者术后最佳矫正视力、眼压、滤过泡及手术并发症情况,并与行超声乳化白内障吸除折叠式IOL植入联合小梁切除术(T-P术)的26例30眼进行比较。患者术后平均随访时间为(9.2±3.5)m。结果①N-P组29例35眼术后1w、1m、6m及12m平均眼压分别为(13.75±3.56)mmHg、(14.12±3.21)mmHg、(13.95±2.32)mmHg和(14.28±3.12)mmHg明显低于术前(29.46±4.48)mmHg(P均<0.01),差异均有显著性意义;术后相同时期与T-P组眼压下降量比较差异均无显著性意义(P均>0.05)。②全部患者术后视力均有不同程度提高。N-P组术后1w、1m、6m及12m最佳矫正视力≥0.5的眼数占随访眼数的百分比分别为65.7%(23/35)、76.5%(26/34)、81.2%(26/32)及84.8%(28/33),与T-P组比较,差异均无显著性意义(χ2值分别为0.427,0.348,0.285,0.256;P均>0.05)。③N-P组患者术后均无明显前房炎性反应、前房变浅,脉络膜脱离等并发症发生。T-P组术后有2眼浅前房,经加压包扎24h后恢复正常。术后房角检查N-P组可见术区后弹力膜及残存小梁网变薄,有3眼可见小梁网处有微穿孔。④两组患者术后均形成滤过泡。随访12m时N-P组33眼中25眼(75.8%)存在功能性滤过泡;T-P组27眼中有21眼(70.4%)存在功能性滤过泡。两组比较无显著性差异(χ2=0.257,P>0.05)。结论N-P术能有效降低眼压、减少抗青光眼药物的应用,疗效好、并发症少,是治疗白内障合并原发性开角型青光眼的有效方法。
Objective To evaluate the clinical effect of phacoemulsification with foldable intraocular lens (IOL) implantation combined with non-penetrating trabecular surgery and amniotic membrane implantation (N-P). Methods 29 patients (35 eyes) with primary open angle glaucoma who underwent cataract surgery were treated with NP technique. The best corrected visual acuity, intraocular pressure, filtration bleb and operative complications were summarized and analyzed. The patients were treated with phacoemulsification 26 cases (30 eyes) with cataract extraction and folding IOL implantation combined with trabeculectomy (TP) were compared. The average postoperative follow-up time was (9.2 ± 3.5) m. Results ① The average IOP at 1w, 1m, 6m and 12m in 35 cases of N-P group were (13.75 ± 3.56) mmHg, (14.12 ± 3.21) mmHg, (13.95 ± 2.32) mmHg and (14.28 ± 3.12) mmHg (29.46 ± 4.48) mmHg before operation (P <0.01), the difference was significant. There was no significant difference in the IOP decrease between TP group and TP group at the same time after operation (P> 0.05). ② All patients with postoperative visual acuity improved to varying degrees. The percentage of eyes with best corrected visual acuity≥0.5 at 1w, 1m, 6m and 12m postoperatively in NP group was 65.7% (23/35), 76.5% (26/34) and 81.2% (26/32), respectively ) And 84.8% (28/33) respectively. There was no significant difference between the two groups (χ2 = 0.427,0.348,0.285,0.256, P> 0.05). ③N-P group patients had no obvious inflammatory reaction of the anterior chamber, anterior chamber shallow, choroidal detachment and other complications occurred. There were 2 eyes of shallow anterior chamber in T-P group and returned to normal after 24 hours. N-P group postoperative visual acuity postoperative elastic membrane and remnant trabecular meshwork thinning, there are 3 eyes trabecular meshwork micro-perforation. ④ After two groups of patients were formed filtration bleb. Functional filtration was observed in 25 eyes (75.8%) of 33 eyes in the N-P group at 12-month follow-up. Functional filtration bleb existed in 21 eyes (70.4%) of the 27 eyes in the T-P group. There was no significant difference between the two groups (χ2 = 0.257, P> 0.05). Conclusion N-P can effectively reduce intraocular pressure and reduce the application of anti-glaucoma drugs. It has good curative effect and few complications. It is an effective method for the treatment of primary open-angle glaucoma.