Application Of Reticulate Sodium Hyaluronate Healaflow In Trabeculectomy For Primary Glaucoma

Objectives To investigate the clinical efficacy and safety of Trabeculectomy combined with reticulated sodium hyaluronate Healaflow implantation in the treatment of primary glaucoma,compare the clinical curative effect with Trabecular resection.Methods In our Department of Ophthalmology,from March 2016 to October 2017,sixty patients with sixty-six eyes primary glaucoma were randomly divided into experimental groups(Trabeculectomy combined with reticulated sodium hyaluronate Healaflow implantation,30 cases,32 eyes)and control group(Trabeculectomy,30 cases,34 eyes).Both the experimental group and the control group had sutured Scleral flaps with adjustable sutures during the operation.Obsered Vision,intraocular pressure,corneal endothelial cell count,anterior chamber reaction,filtering bleb morphology,success rate,and complications on the day after 7 days,1 month,3 months and 6 months after surgery.Statistical analysis was conducted.Results Follow-up at 6 months after surgery,the experimental group was successful in 31 eyes with a total success rate of 96.8%: 28 eyes were completely successful(87.5%),3 eyes were partially successful(9.3%);the control group was successful in 29 eyes with a total success rate of 85.3% : 20 eyes were completely successful(58.9%),9 eyes were partially successful(26.5%).Comparing the total operation success rate between the two groups at 6 months follow-up,the difference was statistically significant,and the test group was higher than the control group(P<0.05).There was no statistically significant(P>0.05)between the two groups at the best corrected visual acuity after the operation and the best corrected visual acuity compared with preoperative best corrected visual acuity in the difference periods after the operation.The corneal endothelial cell counts in the two groups were significantly different from those in the preoperative group(P < 0.05).The corneal endothelial cell counts were lower than those before the surgery in both groups.There was no significant difference in corneal endothelial cell counts between the Healaflow group and the control group(P>0.05).The intraocular pressure was significantly different between after operation and preoperatively of the two groups(P < 0.05).Both groups had lower intraocular pressure than preoperative.There was no difference in intraocular pressure between the two groups at 7 days after operation(P>0.05).There was statistically significant between intraocular in pressure between the two groups at one month,three months and six months after operation(P<0.05).Intraocular pressure was lower in the experimental group than in the control group.There was no significant difference in functional filtering bleb between the two groups at 7 days after operation(P>0.05).There was significant difference in functional filtering bleb between the two groups at 1 month,3 months and 6 months after operation(P<0.05),functional filtration blebs in the experimental group were significantly more than in the control group.There was significant difference in choroidal hypoechoic dark area between the two groups at 7 days after operation(P <0.05).The two groups had no obvious anterior chamber exudate after operation.The patients of the two group had no significant increase in anterior chamber flare,conjunctival hyperemia,eye pain,after operation.1 patient of the Healaflow group and 2 patients of the control group had anterior chamber hemorrhage during operation,stop bleeding with sodium hyaluronate,blood was self-absorbed within 3 days after operation.1 patient of the Healaflow group and 5 patients of the control group had shallow anterior chamber and returned to normal after given atropine mydriasis, topical application of hormone,oral methazolamide,bandage binding eyes,intravenous infusion of mannitol.Intraocular pressure of 3 patients of the experimental group and 4 patients were more than 30 mm Hg within 7 days after surgery.Intraocular pressure dropped below 21 mm Hg after moderate release or removal of adjustable sutures.1 patient of the Healaflow group and 4 patients of the control group developed hypotony,and recovered after the corresponding treatment.3 patients of the control group Filtering bleb leaked.1 patient in the control group occurred alignant glaucoma and recovered after given atropine mydriasis,topical application of hormones,bandage binding eyes,oral methazolamide and intravenous infusion of mannitol.Conclusions Trabeculectomy combined with reticulated sodium hyaluronate Healaflow implantation was beneficial to form Functional filtration bleb and can effectively improve the success rate of surgery,easy to operate.It don't increase the complexity and difficulty of surgery,it is not necessary to change the surgical habits,and it don't increase the surgical trauma of the patient,and is safe and effective.