青光眼小梁切除术后滤过道阻塞的处理  

The treatment of filtering channel blockage after trabeculectomy

作　　者：文勇[1] 白美春[1] 

机构地区：[1]成都市第六人民医院眼科,610051

出　　处：《中华眼外伤职业眼病杂志》2014年第12期925-927,共3页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的探索青光眼小梁切除术后滤过道阻塞等并发症的治疗方法。方法根据我科2010年6月至2013年5月28例（33）眼术后1个月内发生滤过道阻塞患者的临床资料进行总结，参照小梁切除术后滤过道阻塞不同部位采取不同的方法治疗。在术后1个月内切口粘连不紧密时，内部阻塞者通过缩瞳、经角膜侧切口将前粘连的周边虹膜切除口分离，必要时扩大虹膜切口，恢复周边前后房的交通；中部阻塞者重建小梁切口，确保其通畅；外部阻塞者术后1个月内进行结膜瓣、巩膜瓣剥离。结果33眼术后视力情况：5眼视力≤0．1，18眼0．2～0．5，10眼≥0．6。术后眼压12～21mmHg，平均（16．3±3．9）mmHg（1mmHg=0．133kPa）。眼压与术前比较，差异有统计学意义。随访半年，眼压稳定在15～22mmHg，平均（17．3±3．9）mmHg。3例再次手术后需用0．25％噻吗洛尔控制眼压在20mmHg以下。有3例外部滤过道阻塞者行巩膜瓣剥离后出现浅前房。结论小梁切除术后1个月内发生滤过道阻塞者，由于切口愈合并不十分牢固，采取适当的措施是可以恢复滤过功能的。Objective To investigate the treatments for filter channel obstruction after trabeculectomy. Methods From June 2010 to May 2013, the clinical data of 33 eyes of 28 cases with filtering channel blockage within a month after trabeculectomy were reviewed. They were divided into 3 types： inner obstruction, middle obstruction and outer obstruction. Different treatment methods were used according to obstructive locations. Patients with inner obstruction were given miosis,separation of the anterior synechia, and expansion of peripheral iris incision when necessary. Patients with middle obstruction were given reconstruction of the trabecular incision. Patients with outer obstruction were given conjunctival or scleral flap dissection within 1 month after trabeculectomy. Results The visual acuities were ≤ 0.1 in 2 eyes, 0. 2 to 0. 5 in 18 eyes, ≤0.6 in 10 eyes after surgery. The intraocular pressure after surgery was from 12 to 21 mmHg with average （ 16.3 ±3.9） mmHg （ 1 mmHg = 0. 133 kPa） and the difference of intraocular pressure before and after surgery was statistically significant. Followed up for six months, the intraocular pressure stablized between 15 and 22 mmHg with average （17.3±3.9） mmHg. After the second surgery, 0.25% timolol was still needed in 3 eyes to control intraocular pressure within 20mmHg. After stripping scleral flap, shallow anterior chamber appeared in 3 eyes with external filter channel blockage. Conclusion Within one month after trabeculectomy, the filtration function can be restored by taking appropriate measures due to unfirm adhesions of incision.

关 键 词：小梁切除术 青光眼 滤过道阻塞 结膜滤过泡 

分 类 号：R779.6[医药卫生—眼科]