非穿透小梁手术中穿透前房的原因及处理  

Study on intraoperative perforation of the anterior chamber during non penetrating deep sclerectomy

作　　者：方爱武[1] 瞿佳[1] 王勤美[1] 徐明[1] 刘晓强[1] 

机构地区：[1]温州医学院附属眼视光医院眼科,浙江温州325000

出　　处：《眼科》2002年第3期141-143,共3页Ophthalmology in China

摘　　要：目的 :探讨非穿透小梁手术中发生穿透前房的原因及处理。方法 :分析开展的非穿透小梁手术 6 9只眼中 ,发生术中穿透前房的 13例 (14只眼 )的情况及其处理 ,对这 13例患者进行 3～ 12个月的随访 ,行眼压、视力、裂隙灯、眼底镜等检查。结果 :非穿透小梁手术中穿透前房的情况有 :制作深层巩膜瓣时切透或剪穿角巩膜、提巩膜瓣时小梁 后弹力膜裂开、撕开Schlemm管内壁等。微小穿透不处理或行周边虹膜切除 ,穿透范围大 ,改行小梁切除术。平均眼压 ,术前 (2 9 0 4± 8 4 1)mmHg(1mmHg =0 133kPa) ,术后一天 (6 13± 2 92 )mmHg ,经 3～ 12个月随访 ,最后随访眼压 (12 19± 3 2 1)mmHg ,手术前后差异有非常显著性 (t=7 0 0 ,P <0 0 0 1)。结论 :非穿透小梁手术中穿透前房与手术技巧不熟练和手术区解剖不熟悉有关 ,经针对性处理 。Objective:To study the reasons and treatments of perforation of the anterior chamber during non penetrating deep sclerectomy Method:69 eyes of 45 patients were operated with non penetrating deep sclerectomy (NPDS) and perforation of anterior chamber during operation occurred in 14 eyes of 13 patients The conditions of perforation and management to them were analysed retrospectively Vision acuity,intraocular pressure (IOP) measurements,slit lamp examinations and ophthalmicroscope examinations were performed before and after surgery Result:Intraoperative perforation of anterior chamber may occur during dissecting deep scleral flap with scissors or reamer and raising the deep scleral flap and may also occur during tearing the internal wall of Schlemm′s canal In small perforation cases peripheral iris was excised or not and traditional trabeculectomy were done in large perforation case The mean preoperative IOP was (29 04±8 41)mmHg(1mmHg=0 133kPa) The mean postoperative IOP was (6 13±2 92)mmHg at the first postoperative day,and (12 19±3 21)mmHg at the end of follow up(3 12 months).There was significant lowering of IOP after operation(t=7 00,P<0 001) Conclusion:Intraoperative perforation of anterior chamber during deep sclerectomy appears to be related to operator′s experience Proper management in perforation case may provide reasonable control of IOP

关 键 词：青光眼 非穿透小梁手术 手术中并发症 

分 类 号：R779.6[医药卫生—眼科]