超声生物显微镜指导下的原位微创复通术治疗滤过泡纤维化的临床观察

摘要

Objective To investigate the clinical effects of microinvasive revision surgery on the patients of the fibrotic filtering bleb with the guidance of ultrasound biomicroscopy (UBM).Methods A prospective,nonrandomized clinical controlled trial was conducted,which had 2 groups according to the results from UBM during the same period in our hospital,including the patients with the microinvasive revision surgery (28 patients of 28 eyes,group A) and the in-situ traditional revision surgery of larger incision (27 patients of 27 eyes,group B).The clinical data of the patients were collected and the main observation targets were the change of the postoperative visual acuity (VA),intraocular pressure (IOP),the operation success rate and the complications.Results There were no significant differences in the gender,age,glaucoma types,primary operation modes,postoperative follow-up time and preoperative VA (all P ＞0.05).The average duration of hospital stay,postoperative VA and the postoperative complications of group A were better than those of group B and the differences were statistically significant (all P ＜ 0.05).There was no significant difference in IOP at different time points between the two groups (all P ＞ 0.05).The operative successful rates of the two groups were 64.3％ and 66.6％,respectively(P ＞ 0.05).Conclusion The in-situ microinvasive revision surgery on the basis of the UBM examination is a good choice for patients with the fibrotic filtering bleb of the unlocked inner passageway in the filter aisle and a latent liquid dark cavity that is interlinked with the anterior chamber under the scleral flap or the liquid dark cavity of the capsule.%目的 对比观察超声生物显微镜(ultrasound biomicroscopy,UBM)指导下原位微创复通术对滤过泡纤维化患者的临床疗效.方法 对比分析同一时期在我院接受UBM检查后选择行原位微创复通术(28例28眼,A组)和原位复合式滤过性手术(27例27眼,B组)患者的临床资料,主要观察指标包括手术前后的视力、眼压变化、手术成功率、并发症等.结果 两组患者的性别、年龄、青光眼类型、初次手术方式、术后随访时间、术前视力差异均无统计学意义(均为P ＞0.05);A组住院天数、术后3d的视力、术后滤过泡渗漏发生率均优于B组,差异均具有统计学意义(均为P＜0.05);两组术前及术后不同时间点眼压相比,差异均无统计学意义(均为P ＞0.05);A、B两组末次随访时的手术成功率分别为64.3％、66.7％,差异无统计学意义(P＞0.05).结论 对UBM检查滤过道内口通畅且可见巩膜瓣下有与前房相通的潜在的液性暗腔或显示囊状包裹的液性暗腔的术后晚期滤过泡纤维化的患者,原位微创复通术可能是一种较好的选择.