改良巩膜瓣制作在青光眼小梁切除术中的疗效观察  

The Clinical Effect of Improved Scleral Flap in Trabeculectomy for Glaucoma

作　　者：张德玉[1] 邢雁飞[1] 刘新泉[2] ZHANG Deyu;XING Yanfei;LIU Xinquan(Jiading Hospital of Traditional Chinese Medicine,Shanghai 201800,China;Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China)

机构地区：[1]上海市嘉定区中医医院,上海201800 [2]上海中医药大学附属龙华医院,上海200032

出　　处：《中国中医眼科杂志》2025年第2期132-136,163,共6页China Journal of Chinese Ophthalmology

基　　金：上海市嘉定区自然科学研究课题(JDKW-2021-0050)。

摘　　要：目的探讨改良巩膜瓣制作及缝合方法在青光眼小梁切除术中的疗效。方法纳入摩洛哥拉西迪亚大区眼科医院2021年4月—2022年9月收治的青光眼患者98例(98只眼),其中双眼发病8例以临床症状相对较重眼入组,随机分为观察组50例(50只眼)和对照组48例(48只眼)。其中观察组术中采用改良的巩膜瓣制作方法,对照组术中采用常规矩形巩膜瓣手术。记录2组患者的手术时间,术后7 d平均眼压、早期浅前房形成情况及术后14 d功能性滤过泡情况,并进行比较。结果(1)手术时间:观察组平均手术时间低于对照组,差异有统计学意义(t=7.601,P=0.000)。(2)眼压:2组术后7 d平均眼压比较,差异无统计学意义(P>0.05)。(3)浅前房形成情况:观察组术后7 d发生轻度及中度浅前房2例(4.00%),而对照组为10例(20.83%),差异有统计学意义(χ^(2)=8.255,P=0.016)。(4)功能性结膜滤过泡形成情况:2组术后14 d形成功能性滤过泡数量比较,差异无统计学意义(P>0.05)。结论青光眼小梁切除术中采用改良巩膜瓣制作方法,可有效减少手术损伤,缩短手术时间,更好地调控房水滤过率,减小缝线的局部刺激,降低术后浅前房的发生率。OBJECTIVE To investigate the efficacy of a modified scleral flap creation and suturing technique in trabeculectomy for glaucoma.METHODS A total of 98 patients(98 eyes)with glaucoma admitted to the Ophthalmology Hospital of Rachidia Region,Morocco,between April 2021 and September 2022,were enrolled and randomly divided into an observation group of 50 patients(50 eyes)and a control group of 48 patients(48 eyes).The observation group underwent a modified scleral flap creation technique during surgery,while the control group underwent conventional rectangular scleral flap surgery.The operation time,mean intraocular pressure(IOP)at seven days postoperatively,early shallow anterior chamber(SAC)formation,and functional filtering bleb formation at 14 days postoperatively were recorded and compared between the two groups.RESULTS(1)Operation time:The mean operation time in the observation group was shorter than that in the control group,with a statistically significant difference(t=7.601,P=0.000).(2)IOP:The comparison of average IOP seven days post-surgery between the two groups showed no statistically significant difference(P>0.05).(3)SAC formation:There were two cases(4.00%)of mild and moderate SAC in the observation group at seven days postoperatively,and 10 cases(20.83%)in the control group.The difference in the incidence of SAC between the two groups was statistically significant(χ^(2)=8.255,P=0.016).(4)Functional conjunctival filtering bleb formation:The comparison of the number of functional conjunctival filtering blebs formed 14 days post-surgery between the two groups showed no statistically significant difference(P>0.05).CONCLUSIONS The use of a modified scleral flap creation technique in trabeculectomy for glaucoma can effectively reduce surgical trauma,shorten operation time,better regulate aqueous humor filtration rate,decrease local irritation from sutures,and lower the incidence of postoperative SAC.

关 键 词：改良巩膜瓣 小梁切除术 青光眼 

分 类 号：R775[医药卫生—眼科] R276.7[医药卫生—临床医学]