隧道刀制作双层巩膜瓣的青光眼小梁切除术后疗效观察  

Clinical observation of the glaucoma trabeculectomy with tunnel knife making the double- deck scleral flap

作　　者：付敏[1] 喻谦[1] 庄永春[1] 

机构地区：[1]成都医学院第一附属医院眼科,中国四川省成都市610500

出　　处：《国际眼科杂志》2015年第7期1197-1200,共4页International Eye Science

摘　　要：目的:探讨隧道刀制作双层巩膜瓣并切除层间巩膜瓣的青光眼小梁切除术的临床疗效。方法:采用随机分组方法,将46例60眼青光眼患者分为治疗组24例32眼和对照组22例28眼。前者用隧道刀制作双层巩膜瓣,浅层巩膜瓣大小约为5mm×5.5mm,1/3巩膜厚度,瓣下再做一大小约3.5mm×4mm的巩膜瓣,1/3巩膜厚度,切除中间层的巩膜瓣,切除2mm×2mm小梁组织,常规行虹膜周边切除,可调节缝线缝合浅层巩膜瓣,缝合球筋膜、球结膜;后者行常规青光眼小梁切除术。结果:术后随访1a,治疗组视力明显优于对照组,两组比较差异有统计学意义(P<0.05)。两组患者术后眼压均明显低于术前眼压。术后1,3mo时,两组患者的眼压比较差异无统计学意义(P>0.05),但术后6,12mo检查发现,治疗组患者的眼压明显低于对照组,差异有统计学意义(P<0.05)。术后1a治疗组和对照组的累积完全成功率分别为90.63%和75%,两组的累积条件成功率分别为96.88%和89.29%,两组比较差异有统计学意义(均P<0.05)。结论:隧道刀制作双层巩膜瓣并切除层间巩膜瓣的小梁切除术降眼压效果好,巩膜瓣厚薄均匀、表面光滑,滤过泡功能维持时间长,术后并发症少,适用于多种类型的青光眼,值得临床推广。AIM ： To study the trabeculectomy clinical effect of use tunnel knife to make double- deck scleral flap and to cut off the layer scleral flap of glaucom a. METHODS： Using the random grouping method to divide 46 cases（ 60 eyes） of glaucom a into the treatment group of 24 cases（ 32 eyes） and control group of 22 cases（ 28 eyes）. The treatment group,tunnel knife was used to make double- deck sclera flap and superficial scleral flap about the size of 5m m × 5. 5m m,1 /3 scleral thickness,under the sclera flap made another one about the size of3. 5m m ×4m m,1 /3 scleral thickness,resected the middle layer of the sclera flap,rem oved 2m m × 2m m trabecular tissue,underwent routine peripheral iridectomy, could adjust suture the superficial scleral flap, sutured Ball fascia and bulbar conjunctiva. In control group,routine glaucom a trabeculectomy was undergone.RESULTS： Patients were followed up for 1a,the vision in treatm ent group was obviously better than that in the control group,with a statistically significant difference（ P〈0. 05）. The postoperative intraocular pressure of the two groups of patients wre significantly lower than that of the preoperative one. Postoperative 1 and 3mo,no statistical significant difference of intraocular pressure in two group（ P〉0. 05）. But after 6 and 12 mo,the intraocular pressure of the treatm ent group were significantly low er than that of the control group, with statistically significant difference（ P〈0. 05）. Postopeartive 1a,the cumulative com plete success rate and conditions for successful rate were 90. 63% and 96. 88% in the treatm ent group,and those w ere 75% and 89. 29% in control group. There was significant difference between two groups（ P〈0. 05）.CONCLUSION： The trabeculectomy have a good effect to lower the intraocular pressure by use tunnel knife to make double- deck scleral flap and to cut off the layer scleral flap. The scleral flap have uniform thickness, smooth surface,and the function of the filtering bleb maintain

关 键 词：隧道刀 双层 巩膜瓣 青光眼 小梁切除术 

分 类 号：R779.6[医药卫生—眼科]