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目的:探讨房水引流管植入联合羊膜移植对角膜移植术后难治性青光眼的治疗作用。方法:应用α-糜蛋白酶行兔眼后房注射制备青光眼动物模型,把它们随机分为对照组、单纯引流管植入组、引流管植入加羊膜移植组、引流管加羊膜支架植入联合羊膜移植组,观察眼内压、管周组织学改变、引流管周组织渗透性,并且比较各治疗组对难治性青光眼的疗效。临床上,41例(42眼)穿透性角膜移植术后青光眼进行了房水引流管植入联合羊膜移植12眼和单盘Molteno房水引流植入物术30眼,并且比较两种方法的疗效。结果:兔眼后房注射α-糜蛋白酶后,所有的手术眼眼内压升高,术后第3天达到高峰,3天后眼内压渐降。对照组手术3月后眼内压是33.34±5.54mmHg(1mmHg=0.133kPa)。单纯房水引流管组手术3月后眼内压是27.88±8.86mmHg,与对照组相比无显著性降低眼内压的作用(P=0.274)。引流管+羊膜移植组手术3月后眼内压是22.33±3.73mmHg,与对照组相比有显著性降低眼内压的作用(P=0.02),与单独引流管植入组相比无显著性降低眼内压的作用(P=0.113)。引流管+羊膜支架+羊膜移植组手术3月后眼内压是15.74±2.94mmHg,与对照组和引流管组相比均有显著性降低眼内压的作用(P=0.001和P=0.036),与引流管+羊膜移植组相比无显著性降低眼内压的作用(P=0.09)。前
Objective: To investigate the therapeutic effect of aqueous humor drainage tube combined with amniotic membrane transplantation on intractable glaucoma after corneal transplantation. Methods: The animal model of glaucoma was established by injecting α-chymotrypsin into the posterior chamber of rabbits. They were randomly divided into control group, simple drainage tube implantation group, drainage tube implantation and amniotic membrane transplantation group, drainage tube combined with amniotic membrane stent implantation In the amniotic membrane transplantation group, the intraocular pressure, the histological changes of the peri-catheter, and the permeability of the peri-drainage tissue were observed. The curative effect of each treatment group on refractory glaucoma was also compared. Clinically, 41 cases (42 eyes) of post-penetrating keratoplasty glaucoma were treated with aqueous humor drainage tube implantation combined with amniotic membrane transplantation in 12 eyes and single-tray Molteno aqueous drainage implant surgery in 30 eyes, and compared the two methods Efficacy. RESULTS: After injection of α-chymotrypsin in the posterior chamber of the rabbit eyes, intraocular pressure increased in all eyes and peaked on the 3rd postoperative day. The intraocular pressure gradually decreased after 3 days. Intraocular pressure was 33.34 ± 5.54 mmHg (1 mmHg = 0.133 kPa) after 3 months of surgery in the control group. Intraocular pressure was 27.88 ± 8.86 mmHg after 3 months of operation in simple aqueous humor drainage group, with no significant decrease in intraocular pressure (P = 0.274) compared with the control group. The intraocular pressure was 22.33 ± 3.73mmHg after 3 months of operation in the drainage tube + amniotic membrane transplantation group, which was significantly lower than that of the control group (P = 0.02), which was not significantly different from that of the single drainage tube implantation group Sexual reduction of intraocular pressure (P = 0.113). After 3 months of operation, the intraocular pressure was 15.74 ± 2.94mmHg in the drainage tube + amniotic membrane graft + amniotic membrane transplantation group, which significantly reduced the intraocular pressure (P = 0.001 and P = 0.036) compared with the control group and the drainage tube group , No significant reduction of intraocular pressure (P = 0.09) compared with drainage tube + amniotic membrane transplantation group. before