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目的:评价非穿透性小梁手术联合透明质酸钠生物胶植入在原发性开角型青光眼(primaryopen angle glaucoma,POAG)中的临床疗效和治疗作用。方法:对22例24只眼需手术治疗的POAG患者进行非穿透性小梁手术联合透明质酸钠生物胶植入。手术方法是在不打开前房的情况下,切除与Schlemm管内壁平齐的深层巩膜角膜组织,然后植入3mm×4.5mm×0.5mm或3.5mm×3.5mm×3.5mm的透明质酸钠生物胶膜。术后对其眼压、眼内反应情况、滤过泡形态及手术区局部超声生物显微镜(ultrasound biomicroscopy,UBM)检查结果进行分析。随访时间平均3.9±2.2个月。结果:术前平均眼压24.4±9.1mmHg,术后平均15.1±3.7mmHg,差异有显著性(P<0.01)。术前平均用局部降眼压药2.8±1.4种,术后减为0.7±1.0种,差异亦有统计学意义(P<0.01)。所有患者术前与术后的视力变化不大。6只眼术后眼压升高;2只眼有轻度前房出血;无一例出现前房变浅、炎症、脉络膜脱离等并发症。术后1～3个月UBM结果显示透明质酸钠生物胶尚未降解,所有病例在巩膜瓣下形成一透明液间腔,部分病例在结膜下伴有滤过泡形成。结论:非穿透性小梁手术联合透明质酸钠生物胶植入能有效降低高眼压或减少应用青光眼药的种数,无穿透性小梁切除术的严重并发症,术后护理简单,可在门诊开展此手?
Objective: To evaluate the clinical efficacy and therapeutic effect of non-penetrating trabecular surgery combined with sodium hyaluronate bio-implants in the treatment of primaryopen angle glaucoma (POAG). Methods: Twenty - two POAG patients undergoing surgical treatment of 24 eyes underwent nonpermeable trabecular surgery combined with sodium hyaluronate implant. The procedure is to remove the deep scleral corneal tissue flush with the inner wall of the Schlemm tube without opening the anterior chamber and then implant a 3 mm × 4.5 mm × 0.5 mm or 3.5 mm × 3.5 mm × 3.5 mm sodium hyaluronate organism Film. Postoperative intraocular pressure, intraocular reaction, filtering bleb morphology and surgical area under the local ultrasound biomicroscopy (UBM) test results were analyzed. The average follow-up time was 3.9 ± 2.2 months. Results: The mean preoperative intraocular pressure was 24.4 ± 9.1mmHg and the average postoperative 15.1 ± 3.7mmHg, the difference was significant (P <0.01). The average preoperative intraocular hypotensive dose of 2.8 ± 1.4, postoperative reduced to 0.7 ± 1.0, the difference was statistically significant (P <0.01). All patients had little change in visual acuity before and after surgery. The intraocular pressure (IOP) increased in 6 eyes, mild hyphema in 2 eyes, and no complications such as shallow anterior chamber, inflammation and choroidal detachment. The results of UBM 1 to 3 months after operation showed that the sodium hyaluronate gel had not degraded, and all cases under the scleral flap formed a transparent liquid cavity. Some cases were accompanied by filtration bleb formation under the conjunctiva. Conclusion: Nonperforating trabecular surgery combined with sodium hyaluronate bio-implants can effectively reduce the intraocular pressure or reduce the number of glaucoma drugs. There is no serious complications of penetrating trabeculotomy and the postoperative care is simple , Can this hand in the clinic?