目的:评价醛化脐带静脉管(human umbilical vein,HUV)在复合式小梁切除术中治疗难治性青光眼的临床疗效。方法:具有高危因素如新生血管、葡萄膜炎、无晶状体、人工晶状体和发育性的难治性青光眼28例28眼。15例行复合式小梁切除术联合巩膜瓣下HUV植入,13例行复合式小梁切除术。术后观察、比较的指标包括:手术成功率、术后眼内压(intraocular pressure,IOP)、抗青光眼药物使用数量以及术后并发症。所有研究对象随访12mo。结果:术后6mo,手术完全成功:HUV组12/15(80.0%),对照组8/13(61.5%);术后12mo,手术完全成功:HUV组11/15(73.3%),对照组6/13(46.2%)。术后12mo,HUV组和对照组IOP分别从术前50.9±12.2,49.7±11.7mmHg降至17.3±1.1,20.9±2.2mmHg(P=0.00)。由于滤过过强,对照组术后早期出现低眼压2例,HUV组无低眼压;对照组出现包裹性滤过泡4例,HUV组仅出现1例。结论:复合式小梁切除术联合HUV治疗难治性青光眼与复合式小梁切除术相比,具有手术成功率高,术后IOP控制良好、平稳,术后并发症发生率低的特点。

·AIM:To compare clinical outcomes of complex trabeculectomy combined with or without human umbilical vein(HUV)transplantation in refractory glaucoma.METHODS:This clinical trials included 28 eyes with refractory glaucoma at high risks as vascularization,uveitis,aphakia,pseudophakic and young ages.Complex trabeculectomy with HUV transplantation under the scleral flap was performed in 15 eyes and complex trabeculectomy without HUV transplantation in 13 eyes.The outcome measured including surgical success rate,postoperative intraocular pressure(IOP),the number of antiglaucoma medications and complications.All patients were followed for 12 months.RESULTS:Complete success was seen in 12/15(80.0%)study eyes and 8/13(61.5%)control eyes at 6 months postoperatively,and in 11/15(73.3%)and 6/13(46.2%)at 12 months after surgery,respectively.IOP decreased from 50.9±12.2mmHg and 49.7±11.7mmHg preoperatively in study and control groups to 17.3±1.1mmHg and 20.9±2.2mmHg,respectively at 12 months(P=0.00).Early postoperative hypotony developed in 2 control eyes owing to excessive filtration but none of study eyes.Encapsulated bleb occurred in 4 control eyes but in 1 study eye.CONCLUSION:In refractory glaucoma,complex trabeculectomy combined with HUV transplantation compared to without HUV transplantation has higher success rate,lower postoperatively mean IOP,and lower complication rate.

R779.6

中国辽宁省教育厅科研基金资助项目(No.202013128)