深层巩膜瓣及球筋膜切除对穿透性小梁切除术滤过功能的影响  

The impact of deep scleral flap and Tenon's capsule excision on filtration of trabeculectomy

作　　者：陈海英[1] 黄正如[1] 徐明[1] 陆炯[1] 

机构地区：[1]常熟市第二人民医院眼科,江苏215500

出　　处：《交通医学》2009年第1期23-25,28,共4页Medical Journal of Communications

摘　　要：目的:探讨深层巩膜瓣及球筋膜切除对青光眼小梁切除术滤过功能的影响。方法:双眼原发性慢性青光眼患者49例,随机选择一眼作为标准组,行标准小梁切除术;对侧眼为改良组,在标准小梁切除术的基础上作深层巩膜瓣及球筋膜切除。术后观察眼压、滤过泡形态、并发症以及超声生物显微镜(UBM)检查。结果:两组术后眼压在1、2、3月时无明显差异(P为0.3671、0.1331、0.9685),而在术后6、12、18月时,改良组的眼压低于标准组(P为0.0003、0.0196、0.0224)。术后6月有功能滤过泡与无功能滤过泡的构成比在两组间的差异具有显著性(P=0.0320);两组间巩膜瓣下滤道形成状况不同(P=0.022)。结论:深层巩膜瓣及球筋膜切除促进功能性滤过泡的形成,并可获得较低的术后眼压;深层巩膜瓣切除有利于巩膜瓣下滤过道的形成,可简化失败病例的再手术。Objective：To assess the impact of deep scleral flap and Tenon＇s capsule excision on filtration of trabeculectomy. Methods：Random unilateral eyes as the standard group were operated on standard trabeculectomy in 49 patients with bilateral primary glaucoma and the contra-lateral eyes as modified group were for modified trabeeulectomy in which a deep scleral flap and Tenon＇s capsule were removed in addition to ablation of the trabecular meshwork. The intra-ocular pressure（IOP）, bleb formation, complications were observed and ultrasonic biomicroscope （UBM） examination of sclerectomy site were performed postoperation. Results：IOP of the modified group was lower than that of the standard group at the 6th, 12th, and 18th month post-operation （P=0.0003, 0.0196, 0.0224）; at the 6th month post- operation, there was no significant difference between the ratio of functional bleb of the two groups （P=0.0770）, and all of the eyes of the modified group maintain the filtration pathway under the seleral flap while 6 eyes of the standard group did not. Conclusions：Deep scleral flap and Tenon＇s capsule excision could improve the formation of functional bleb, also could control IOP at a lower level; Deep scleral flap removal could maintain the filtration pathway under the scleral flap, which could simplify the re-operation on fihration failure cases.

关 键 词：青光眼 小梁切除术 巩膜瓣 球筋膜 

分 类 号：R775[医药卫生—眼科]