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目的评价两种巩膜瓣可调整缝线在青光眼小梁切除术中应用的临床效果。方法对原发性青光眼首次接受小梁切除术136例(142眼)进行随机分组,术毕采用巩膜瓣可调整缝线。67例(70眼)采用Kolker法作为A组,69例(72眼)采用Shin法作为B组。比较两组术后自觉症状、前房深度、滤过泡形态、眼压情况。结果术后术眼有酸、磨、溢泪等自觉症状的A组30眼,B组2眼,两组比较差异有统计学意义;术后浅前房A组3眼(4.29%),B组4眼(5.56%),两组比较差异无统计学意义;随访6个月,滤过泡形态A组Ⅰ型7眼,Ⅱ型59眼,Ⅲ型3眼,Ⅳ型1眼,功能型滤过泡66眼(94.29%);B组Ⅰ型15眼,Ⅱ型51眼,Ⅱ型1眼,Ⅳ型5眼,功能型滤过泡66眼(91.67%)。功能型滤过泡两组比较差异无统计学意义,但Ⅳ型滤过泡A组与B组差异有统计学意义;眼压情况两组差异无统计学意义。结论两种巩膜瓣可调整缝线均能提高青光眼小梁切除术成功率,但Kolker法自觉症状明显,Shin法滤过泡易局限,必要时可两种缝线联合应用。
Objective To evaluate the clinical effect of two scleral flap adjustable sutures in glaucoma trabeculectomy. Methods 136 cases (142 eyes) with primary glaucoma who underwent trabeculectomy were randomly divided into groups, scleral flap was used to adjust the suture after operation. Sixty-seven patients (70 eyes) received Kolker’s method as group A, and 69 patients (72 eyes) received Shin’s method as group B. The postoperative symptoms, anterior chamber depth, filtration bleb morphology and intraocular pressure were compared between the two groups. Results There were 30 eyes in group A, 2 eyes in group B, there were significant differences between the two groups (P <0.05). There were 3 eyes (4.29%) in group A Group 4 eyes (5.56%), there was no significant difference between the two groups. After 6 months of follow-up, there were 7 eyes of type B, 59 eyes of type Ⅱ, 3 eyes of type Ⅲ, 1 eyes of type Ⅳ, There were 66 eyes (94.29%) of filtering bleb, 15 eyes of type B, 51 eyes of type Ⅱ, 1 eyes of type Ⅱ, 5 eyes of type Ⅳ and 66 eyes of functional filtering blisters (91.67%). There was no significant difference in functional filtration bleb between the two groups, but there was significant difference between group A and group B in type IV filtration bleb. There was no significant difference in IOP between the two groups. Conclusion Both suture scleral suture can improve the success rate of trabeculectomy in glaucoma. However, the symptoms of Kolker are obvious, and the filtration by Shin method is easy to be limited. If necessary, two kinds of sutures can be used in combination.