改良式双层高位结膜瓣小梁切除术的临床观察  

Clinical study on modified trabeculectomy with double layer of high position conjunctival flap.

作　　者：冯长顺[1] 孟海林[1] 马锦霞[1] 史芳荣 杨东海[1] 张红亮 常新琦 何颜清 王瑞[1] 

机构地区：[1]安阳市眼科医院,455000

出　　处：《眼外伤职业眼病杂志》2001年第6期627-629,共3页Journal of Injuries and Occupational Diseases of the Eye with Ophthalmic Surgeries

摘　　要：目的　为提高小梁切除术的成功率 ,探讨减少滤泡渗漏、浅前房、葡萄膜炎症反应及非功能性滤泡形成等并发症的手术方法。方法　对以角膜缘为基底结膜瓣的小梁切除术进行改良 :采用双层高位结膜瓣 ,结膜切口距角膜缘 9mm以上 ( 9～ 15mm) ,分层切开结膜及筋膜并分层缝合 ,预先虹膜根部切透 ,以降低后房压力 ,足够大的周边虹膜切除 ,自角膜表面恢复虹膜 ,以及术中开始应用阿托品散瞳等。结果　通过 190例 2 89眼的改良式小梁切除术 ,经过平均 3 1年随访 ,眼压控制率为 90 66% ,功能性滤泡占 89 2 7% ,视野改善率为 33 33% ,浅前房发生率为 2 8 0 3%。结论　本组小梁切除术的几点改良 ,设计合理 。Objective To make further improvement on the success rate of trabeculectomy,try to find out the better surgical technique to decrease the complication rate such as bleb leak,flat anterior chamber,uveitis,non function bleb formation and so on .Methods The trabeculectomy with the use of limbus based conjunctival flap was modified.The modifications included the using of double layer and high position conjunctival flap,the long distance (9～15 mm) of the placement of the conjunctival incision to the limbus,a separate insion through conjunctiva and slightly lower incision through Tenon's capsule,which were closed separatly with a running suture,the preceding penetrating incision of iris root to lower the pressure of the posterior chamber,the big enough peripheral iridectomy,repositioning of the iris on the surface of the cornea,starting dripping atropine drops in the operation and so on.Results 190 cases (289 eyes) with glaucoma treated by this modified surgery.The mean period of postoperative follow up was 3.1 years.The results were controlled intraocular pressure in 262 eyes (90.66%),the function bleb in 258 eyes (89.27%),improvement of the visual field in 59 eyes (33.33%),flat anterior chamber in 81 eyes (28.03%),delayed formation of the anterior chamber in 26 eyes (9%), uveitis in 15 eyes (5.19%),choroidal detachment in 18 eyes(6.23%).Conclusion The methods of our modified trabeculectomy technique are effective and reasonable.

关 键 词：结膜瓣 小梁切除术 青光眼 

分 类 号：R779.6[医药卫生—眼科]