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应用超声生物显微镜 (UBM)检查技术 ,探讨非穿透性小梁手术联合透明质酸钠生物胶植入手术区域解剖特点和房水引流机制。方法 :对 14例 16只眼行非穿透性小梁手术联合透明质酸钠生物胶植入的患者 ,在术后 1～ 3个月内进行手术区域 UBM检查。检查的指标 (项目 )包括 :巩膜瓣下形成液间腔的大小 (宽和高 )、透明质酸钠生物胶吸收的情况、剩余角膜小梁膜的厚度以及滤过泡的形态 ,并对结果进行分析。结果 :16只眼术前平均眼压 2 3.43± 7.6 1mm Hg,术后 3个月时平均 14.6 5± 3.6 2 mm Hg,差异有显著性 (P<0 .0 1)。术后 1～ 3个月 U BM结果显示透明质酸钠生物胶尚未降解 ,所有病例在巩膜瓣下形成一透明液间腔 ,宽平均 3.2 0± 0 .91mm,高平均 0 .6 5± 0 .17mm。剩余角膜小梁膜厚度平均为 0 .0 8± 0 .0 7mm,如此层太厚 ,往往引起术后眼压升高。 5眼在结膜下伴有滤过泡形成。 1眼可见有脉络膜分离回声暗区。结论 :非穿透性小梁手术联合透明质酸钠生物胶植入降低眼压的机制是房水籍剩余的角膜小梁膜向包括了巩膜瓣下间腔、巩膜瓣周围、结膜下和脉络膜上腔引流的方式。手术的关键是充分切除深层巩膜瓣 ,残留菲薄角膜小梁膜 ,使房水自发性渗出。
Application of ultrasound biomicroscopy (UBM) examination techniques to explore non-penetrating trabecular surgery combined with sodium hyaluronate bio-gel regional anatomy and drainage characteristics of aqueous humor drainage mechanism. Methods: 14 cases of 16 eyes underwent non-penetrating trabecular surgery combined with sodium hyaluronate implant. UBM was performed within 1 to 3 months after operation. Indicators (items) of the examination included the size (width and height) of liquid chambers formed under the scleral flap, the absorption of sodium hyaluronate gum, the thickness of the remaining corneal trabecular membrane, and the morphology of the filtered bleb, and the results Analyze. Results: The average intraocular pressure before operation was 2343 ± 7.6 1 mm Hg in 16 eyes and 14.6 5 ± 3.6 2 mm Hg at 3 months after operation. The difference was significant (P <0.01). U BM results showed that the sodium hyaluronate gel has not degraded 1 to 3 months after operation. All patients under the scleral flap formed a transparent liquid cavity with a mean width of 3.2 ± 0.91 mm and a high average of 0.665 ± 0 .17mm. The remaining corneal trabecular membrane thickness average 0.08 ± 0. .0 7mm, so thick layer, often cause postoperative intraocular pressure. 5 eyes in the conjunctiva associated with filtration bleb formation. One eye can be seen with choroidal echo echo dark areas. CONCLUSION: The mechanism of non-penetrating trabecular surgery combined with sodium hyaluronate bio-implants in reducing intraocular pressure is that the remaining corneal trabecular membrane of Amniotic fluid is composed of a large amount of corneal trabeculae covered by the subspace of the scleral flap, the periphery of the scleral flap, the subconjunctival and the choroid Drainage on the way. The key to surgery is to fully resect the deep scleral flap, residual thin corneal trabecular membrane, so that spontaneous exudation of aqueous humor.