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目的 观察复合式小梁切除术治疗难治性青光眼及原发性青光眼的疗效。方法 对 1998年 7月至2 0 0 0年 5月收治的难治性青光眼、晚期原发性开角型青光眼、前房极浅或疑有恶性青光眼倾向的原发性闭角型青光眼 38例 (38只眼 )进行复合式小梁切除术。术后根据眼压水平、滤过泡形态及前房情况适时拆除巩膜瓣缝线。定期随访患者平均 14± 2 .9个月。内容包括 :眼压、视力、滤过泡、前房、晶状体及眼底。结果 6只眼术后因眼压控制良好未作缝线拆除 ;32只眼分别于术后 3～ 31天拆线 ,拆线时间平均 12 .1± 7.9天 ,拆线后眼压平均下降 10 .1± 5 .4 m m Hg。患者术后一周平均眼压 13.7± 5 .9mm Hg,与术前平均眼压 2 6 .6± 10 .1mm Hg相比 ,差异有非常显著性。术后 12个月末时眼压≤ 2 1m m Hg者 32只眼 (84 .2 % ) ,其中 2 8只眼眼压≤ 15 m m Hg。 12个月末时功能性滤过泡的累积存活率为 80 .1± 5 .4 %。术后 33只眼呈中度或深前房 ;4只眼术后第一天前房浅 度 ,经药物治疗前房逐渐加深 ;1只眼因伴发脉络膜脱离发生 度浅前房。并发症有前房积血 4只眼 ,脉络膜脱离 1只眼 ,无血管的薄壁微囊样滤过泡 1只眼 ,持续性低眼压 2只眼 ,低眼压性黄斑病变 1只眼。结论 复合式小梁切除术既可避免术后早期滤过过强?
Objective To observe the curative effect of compound trabeculectomy in refractory glaucoma and primary glaucoma. Methods Thirty-eight cases of primary angle-closure glaucoma who were refractory glaucoma, advanced primary open-angle glaucoma, minimally anterior chamber or suspected malignant glaucoma admitted from May 1998 to May 2000 were enrolled in this study. (38 eyes) for trabeculectomy. According to the level of intraocular pressure, filtration bleb morphology and anterior chamber conditions timely removal of scleral suture. Patients were followed up on average 14 ± 2.9 months. Contents include: intraocular pressure, visual acuity, filtered bleb, anterior chamber, lens and fundus. Results All the eyes underwent good intraocular pressure control without suture removal. 32 eyes were stitched separately from 3 to 31 days after operation, the average stitches removal time was 12.1 ± 7.9 days, and the IOP decreased 10 .1 ± 5 .4 mm Hg. The mean intraocular pressure (IOP) of one week after operation was 13.7 ± 5.9 mm Hg, which was significantly different from the preoperative mean IOP of 26.6 ± 10.1 mm Hg. Twenty-two eyes (84.2%) had intraocular pressure ≤ 21 m Hg at the end of the 12 months after operation, of which 28 had intraocular pressure ≤ 15 m Hg. The cumulative viability of functional bleb was 12.1 ± 5.4% at the end of 12 months. 33 eyes were moderate or deep anterior chamber; 4 eyes after surgery the first day of shallow light, the anterior chamber gradually deepened by medication; 1 eye due to the occurrence of choroidal detachment associated with shallow anterior chamber. Complications of anterior chamber hemorrhage in 4 eyes, choroidal detachment in 1 eye, avascular thin-walled microcapsule filtration bleb 1 eye, persistent low intraocular pressure in 2 eyes, low intraocular pressure macular degeneration in 1 eye. Conclusion Combined trabeculectomy can prevent early postoperative filtration too strong?