内路Schlemm管成形术治疗原发性开角型青光眼疗效及安全性观察

doi:10. 13281/j. cnki. issn.1004-4469. 2020. 01. 005

眼科

内路Schlemm管成形术治疗原发性开角型青光眼疗效及安全性观察

周龙芳胡迭蓝婕吕明原谢立信潘晓晶

山东省眼科研究所山东第一医科大学附属青岛眼科医院，青岛 266071

收稿日期:2019-04-15 出版日期:2020-01-25 发布日期:2020-02-12
通讯作者: 潘晓晶，Email：panxjcrystal36@163.com
基金资助:
山东省重点研发计划项目（2018GSF118103）；山东省医学科学院院级科技计划（2017-18）

Efficacy and safety of ab interno canaloplasty for primary open-angle glaucoma

Zhou Longfang, Hu Die, Lan Jie, Lv Mingyuan, Xie Lixin, Pan Xiaojing

Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, China

Received:2019-04-15 Online:2020-01-25 Published:2020-02-12
Contact: Pan Xiaojing, Email: panxjcrystal36@163.com
Supported by:
Key Research and Development Program of Shandong Province (2018GSF118103); Science and Technology Program of Shandong Academy of Medical Sciences (2017-18)

摘要/Abstract

摘要： 目的观察内路Schlemm管成形术治疗原发性开角型青光眼的疗效及安全性。设计回顾性病例系列。研究对象 2018年10月-2019年3月青岛眼科医院诊治的原发性开角型青光眼30例30眼。方法所有研究对象均行内路Schlemm管成形术，经透明角膜切口进入前房，在前房内水平切开小梁网和Schlemm管内壁，切口宽约1mm，将iTrack微导管尖端对齐切口并插入Schlemm管内，进行360°扩张。术后随访3个月。Schlemm管开放情况采用海德堡前段OCT进行检查。Image J进行OCT图像分析，测量Schlemm管宽度、长度。主要指标眼压、降眼压药物数量、Schlemm管开放程度。结果 30例原发性开角型青光眼患者360°穿行成功率83.33%。术前平均眼压（30.43±8.65）mmHg，术后1天、1周、1个月、3个月平均眼压分别为（14.33±3.88）mmHg、（18.21±7.52）mmHg、（16.55±4.92）mmHg、（16.61±3.99）mmHg，术后各时间点眼压较术前明显下降（P＜0.001）。术前降眼压药物数量平均为（2.73±0.91）种，术后1周、1个月、3个月分别为（0.84±1.25）种、（0.75±0.91）种、（0.92±0.95）种，术后降眼压药物数量明显减少（P＜0.001）。术前Schlemm管平均横径、纵径分别为（255.22±59.67）μm、（37.89 ±12.00）μm，术后分别为（306.11±59.44）μm、（64.22±34.62）μm（P=0.02、0.04）。术后1周、1个月、3个月的手术成功率分别为69.23%、85.00%、84.61%。术后发生前房积血者46.67%，出血性后弹力膜分离者3.33%。结论内路Schlemm管成形术对原发性开角型青光眼有较好的短期疗效，严重并发症低，是一种安全有效的微创青光眼手术。（眼科，2020, 29： 20-25）

关键词: 原发性开角型青光眼, 内路Schlemm管成形术

Abstract: Objective To observe the efficacy and safety of ab interno canaloplasty for primary open-angle glaucoma. Design Retrospective case series. Participants 30 eyes (30 cases) of primary open-angle glaucoma during October 2018 to March 2019 in Qingdao Eye Hospital. Methods All subjects underwent ab interno canaloplasty, which was performed through a transparent cornea incision into the anterior chamber. Trabecular meshwork and the inner wall of Schlemm tube were horizontally cut with an incision about 1 mm. The tip of iTrack microcatheter was aligned with the incision and inserted into Schlemm tube for 360 expansion. Follow-up for 3 months after operation was conducted. The opening of Schlemm tube was examined with Heidelberg anterior segment OCT. Image J performed OCT image analysis to measure Schlemm tube width and length. Main Outcome Measures Intraocular pressure (IOP), amount of intraocular pressure lowering drugs used, opening degree of schlemm tube. Results Among the 30 patients, the success rate of 360 degree crossing was 83.33%. The preoperative mean IOP was (30.43±8.65) mmHg. The postoperative mean IOP at 1 day, 1 week, 1 month and 3 months were (14.33±3.88) mmHg, (18.21±7.52) mmHg, (16.55±4.92) mmHg and (16.61±3.99) mmHg. The IOP at each time point after operation was significantly lower than that before operation (P<0.001). The average number of IOP-lowering drugs used before surgery was (2.73±0.91), and the number of IOP-lowering drugs used after surgery was (0.84±1.25), (0.75±0.91) and (0.92±0.95) at 1week, 1 and 3 months (P<0.001). The mean transverse diameter and longitudinal diameter of Schlemm tube were respectively (255.22±59.67) μm and (37.89±12.00) μm before operation and (306.11 59.44) μm and (64.22 34.62) μm after operation (P=0.02, 0.04). The success rates of 1 week, 1 month and 3 months after operation were 69.23%, 85.00% and 84.61%. The most common postoperative complication was hyphema (46.67%), and the incidence of hemorrhagic posterior elastic membrane separation was 3.33%. Conclusion Ab interno canaloplasty is a safe and effective minimally invasive surgery for primary open angle glaucoma with good short-term effect and low complication. （Ophthalmol CHN, 2020,29: 20-25）

Key words: primary open angle glaucoma, ab interno canaloplasty

周龙芳胡迭蓝婕吕明原谢立信潘晓晶. 内路Schlemm管成形术治疗原发性开角型青光眼疗效及安全性观察[J]. 眼科, doi: 10. 13281/j. cnki. issn.1004-4469. 2020. 01. 005.

Zhou Longfang, Hu Die, Lan Jie, Lv Mingyuan, Xie Lixin, Pan Xiaojing. Efficacy and safety of ab interno canaloplasty for primary open-angle glaucoma[J]. Ophthalmology in China, doi: 10. 13281/j. cnki. issn.1004-4469. 2020. 01. 005.

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内路Schlemm管成形术治疗原发性开角型青光眼疗效及安全性观察

Efficacy and safety of ab interno canaloplasty for primary open-angle glaucoma

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