复合式小梁切除术在难治性青光眼的应用  

The Application of the Compound Trabeculectomy on Recalcitrant Glaucoma

作　　者：纪泽江 余志洪 魏琳 谭晏华 

机构地区：[1]韶关市第一人民医院眼科,广东韶关512000

出　　处：《华西医学》2005年第1期93-94,共2页West China Medical Journal

摘　　要：目的 :探讨复合式小梁切除术在难治性青光眼的临床效果。方法 :对 36例 4 2眼的难治性青光眼 ,在表面麻醉加球结膜下麻醉后采用小梁切除术、丝裂霉素和可松解缝线的缝合等一系列方法进行治疗 ,术后对视力、视野、前房、眼压、滤过泡形态进行观察 ,总结分析疗效。结果 :36例 4 2眼术后都经半年以上的随访 ,术前平均眼压 (32 6± 4 9)mmHg,术后 (14 9± 3 0 )mmHg,下降率为 5 4 3% ,手术前后有非常显著性差异 (P <0 0 1)。其中 33例 39眼术后未用降压药 ,眼压控制在 8～2 1mmHg之间 ,2例 2眼局部用一种抗青光眼眼药水 ,眼压控制在 2 1mmHg以下 ,一例近绝对期青光眼 ,术后眼压未能控制在2 1mmHg以下 ,因患者无明显不适未作进一步处理。术后视力无改变的 32例 38眼 ,1例 1眼因眼底出血 ,经治疗视力不稳定 ,3例 3眼因原有的晶体混浊加重而引起视力下降 ,4 2眼中Ⅰ型滤过泡 2 9眼 ,Ⅱ型滤过泡 12眼 ,Ⅲ型滤过泡 1眼 ,功能性滤过泡占 97 6 %。结论 :复合式小梁切除术 ,术式简单、安全、效果好、易掌握 ,是难治性青光眼一种理想的手术方式。Objective： Discuss the clinical effect of Compound Trabeculectomy on Recalcitrant C, laueoma. Method： for 36 eases 42 eyes of recatcitrant glaucoma, a series of methods are adopted after surface anesthesia and subonjunctival anesthesia, such as trabeculectomy, mitomycin, and loosenalde suture. Observe anterior clamber, intraocular pressure, vision, and filtration bleb shape after （he therap, summarize and analyze the curative effect. Results： 36 Cases 42 eyes were followd more than halfa year after the surgical therapy. The average intraocular pressure （IOP） before the surgical therapy is （32.6± 4.9） mmHg, it reduces to （ 14.9 ± 3.0） mmHg after the surgical therapy, the descendent rate reaches 54.3% . %ere is great difference between before and ＇after the surgical therapy, （ P 〈 0.01 ） . Among them, medicine of lowering pressure is not used after the surgical therapy for 33 eases 39 eyes, intraoeular pressure is controlled betweeu 8 and 21 wanHg. 2 eases 2 eyes take a kind of topical glaucoma drag, intraoeular pressure is controlled below 21 mmHg. One ease of late glaucoma, intraocular pressm＇e can t be controlled below 21 mmHg, but since the patient feels no obvious discomfort, there is no further treatrnent. Mnong those. 32 eases 38 eves, which vision doesn＇t ehange after the surgical therapy, 1 ease 1 eye, vision beeomes unstable after the therapy because, of fundus hemorrhage. 3 eases 3 eyes, vision weakens caused by the aggravation of opacity of the len. Among the 42 eyes, Ⅰ type filtration bleb 29 eyes, Ⅱ type filtration bleb 12 eyes, Ⅲ type filtration bleb 1 eye, and fimctional filtration bleboccupies97.6%. Conclusion： Compound Trabeeuleetomy, simple, safe, and highly effective, ease to master, it is an ideal therapy which suits RecaMtrant Glaucoma perfectly.

关 键 词：青光眼 复合式小梁切除术 可松解缝线 丝裂霉素 

分 类 号：R779.6[医药卫生—眼科]