Clinical Observation Of Combined Surgery Of Ocular Tenonectomy,Trabeculectomy And Amniotic Membrane Transplantation For The Treatment Of Primary Open Angle Glaucoma

ObjectiveTo evaluate the effect of combined surgery of ocular tenonectomy, trabeculectomy and amniotic membrane transplantation for the treatment of primary open angle glaucoma.MethodsA retrospective analysis method study. Sixty-five eyes of 48 cases with advanced open-angle glaucoma were treated with trabeculectomy and tenonectomy(excision of tenon s capsure) combined with biological amniotic membrane transplantation under scleral flap. Patients were followed up for 6 to 18 months, visual acuity, intraocular pressure, funders, the type of blebs, the successful rate, complication and the anti-glaucoma medications were recorded on the 1,2weeks, 1,3,6,9,12,18 months after surgery.Results(1) After surgery all patients showed no statistically significant drop in the visual acuity, there were no statistically significant differences in visual acuity between preoperative period and postoperative period and there was no severe postoperative complications(P>0.05).(2) The average IOP at 1,2 weeks,1,3,6,9,12 and 18 months after surgery was significant different from the preoperative level(P>0.05). But transient elevated IOP was observed in 5 eyes during 1 week after surgery, and massaged on eyeball and the filter-bubble become over the nature, removal of adjustable suture. Followed up for 6 to 18 months, the IOP of the 5 eyes were controlled(16~20.5) mm Hg by less than one or two kinds of anti-glaucoma medication.(3) The cup/disc ratio were 0.85±0.30 preoperatively and 0.83±0.30 postoperatively, and there had no significant differences(t=-0.463,P>0.05).(4) MD were(-14.69±2.51) d B preoperatively and(-16.73±3.36) d B 、(-18.87±3.52) d B during 3、6 month after surgery, which were no statistically different(P>0.05);PSD were(9.21±3.29) d B preoperatively and(8.18±2.62) d B、(8.616±3.15)d B posstoperatively 3、6 month(P>0.05).(5) All patients were formed functional blebs at the 1 month after surgery. There were 86.15%(56/65) have I type and II type blebs at the 6 month after surgery. But only 80.36%(45/56) were controlled in the normol range of IOP. The IOP of 11 eyes were controlled by less than one kind of anti-glaucoma medication. 9 eyes were formed non-functional blebs, in which there IOP of 8 eyes be controlled by less than one kind of anti-glaucoma medication. Functional filter bleb formed in 80.65%(25/31) of patients 18 months after the operation.(6) The complete success rate and condition success rate were 69.23%(45/65) and 24.62%(16/65), respectively.(7) After surgery all patients showed no significant severe complcations.9 eyes occurred shallow anterior, in which 5 eyes occurred I degree shallow anterior chamber and 4 eyes occurredⅡdegree at postoperative one week. Shallow anterior chamber is not treated, or by atropine mydriatic, compression bandage anterior chamber within 10 d after recovery.ConclusionThe combined surgery of ocular tenonectomy, trabeculectomy and amniotic memebrane transplantation for treatment of open-angle glaucoma was safe and efficient. The patient’s IOP was decreased, reduced the filtering bleb scarring and the incidence of functional bleb was increased significantly, and the shallow anterior chamber was lower after the surgery.