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目的评价非穿透小梁手术治疗原发性开角型青光眼(POAG)的远期疗效与失败原因。设计随机化临床试验。研究对象POAG患者105例(111眼)。方法对55眼和56眼分别非穿透小梁手术和复合式小梁切除术,术后随访30~48个月。主要指标视力、眼压、滤过泡、前房角、并发症。结果术后48个月非穿透小梁手术组视力优于复合式小梁切除组(χ2=7.7381,P<0.05)。在6、12、24、36、48个月时非穿透小梁手术组和复合小梁切除组手术成功率分别为91%、77%、70%、67%、60%和91%、86%、82%、81%、78%。6、12、24、36个月两组间比较无显著性差异(χ2=0.08、0.748、2.93、3.53;P>0.05),但48个月时非穿透小梁手术组手术成功率显著低于复合小梁组(χ2=5.26,P<0.05)。非穿透小梁手术组48个月时功能性滤过泡保存仅占47%,少于复合小梁切除组(76%)。非穿透小梁手术组术区滤过膜发生纤维化增厚30例(54.5%),虹膜周边前粘连12例(21.8%)。结论非穿透小梁手术组术后6个月前与复合式小梁切除术手术成功率相当,而远期则低于复合式小梁切除术。术后眼压升高,除滤过泡瘢痕化因素外与手术区滤过膜的纤维化增厚及虹膜周边前粘连导致房水滤过减少密切相关。
Objective To evaluate the long-term efficacy and failure of non-penetrating trabecular surgery in the treatment of primary open-angle glaucoma (POAG). Design randomized clinical trials. The study included 105 POAG patients (111 eyes). Methods 55 eyes and 56 eyes were treated with non-penetrating trabecular surgery and trabeculectomy respectively. The patients were followed up for 30 to 48 months. The main indicators of vision, intraocular pressure, filtration bleb, anterior chamber angle, complications. Results At 48 months after operation, the visual acuity of non-penetrating trabecular surgery group was better than that of composite trabeculectomy group (χ2 = 7.7381, P <0.05). At 6, 12, 24, 36 and 48 months, the successful rates of non-penetrating trabecular surgery and trabeculectomy were 91%, 77%, 70%, 67%, 60% and 91%, respectively %, 82%, 81%, 78%. At 6, 12, 24 and 36 months, there was no significant difference between the two groups (χ2 = 0.08,0.748,2.93,3.53; P> 0.05). However, the success rate of operation in non-penetrating trabecular surgery group was significantly lower at 48 months In the composite trabecular group (χ2 = 5.26, P <0.05). Functional filtration of bleb was only 47% at 48 months in the non-penetrating trabecular surgery group, less than in the trabeculectomy group (76%). In the non-penetrating trabecular surgery group, there were 30 cases (54.5%) of fibrosis thickening and 12 cases (21.8%) of anterior iris adhesions. Conclusion The success rate of non-penetrating trabecular surgery group was the same as that of composite trabeculectomy 6 months after surgery, but lower than that of combined trabeculectomy in non-penetrating trabecular surgery group. Postoperative intraocular pressure increased, in addition to filtering bleb scarring factor outside the surgical area filtration membrane fibrosis and thickening of the iris before adhesion leading to atrial fibrillation is closely related to reduced.