两种瓣式小梁切除术后辅助眼球按摩对形成功能性滤过泡的影响

目的:比较穹隆部为基底的球结膜瓣和角膜缘为基底的球结膜瓣在青光眼复合式小梁切除术后辅助眼球按摩治疗对形成功能性滤过泡的影响。方法:将51例61眼原发青光眼并接受复合小梁切除术患者随机分成两组:A组26例31眼以角膜缘为基底的球结膜瓣;B组25例30眼以穹隆部为基底的球结膜瓣。术后观察两组患者眼压、滤泡、前房深度,并根据情况适时辅助眼球按摩治疗。全部患者术后观察6mo。结果:两种结膜瓣的复合式小梁切除术均有显著降眼压效果(P<0.01);功能性滤过泡的形成率也无统计学差异(P>0.05);术后早期眼球按摩促进滤泡形成中出现被动性滤泡渗漏B组多于A组。结论:两种结膜瓣的复合小梁切除术治疗青光眼都有相同良好的效果。眼球按摩可促进形成功能性滤过泡。角膜缘为基底球结膜瓣的复合小梁切除术后眼球按摩治疗不易出现被动性滤泡渗漏。     

两种结膜瓣式小梁切除术的比较

目的：比较两种结膜瓣式小梁切除术的临床效果。

方法：将我院132例148眼行青光眼小梁切除术的原发性青光眼的患者分为以角膜缘为基底的结膜瓣(A组)64例72眼和以穹隆部为基底的结膜瓣(B组)68例76眼两组,术后随访6～12mo,观察眼压、滤过泡、前房深度及术中术后并发症。

结果：两种术式在术后成功率及术后降眼压效果上无明显的统计学差异。以穹隆部为基底的结膜瓣(B组)能得到更理想的滤过泡。以角膜缘为基底的结膜瓣(A组)表现出更多的并发症,如晚期滤过泡渗漏、低眼压等。

结论：以穹隆部为基底的结膜瓣(B组)优于以角膜缘为基底的结膜瓣(A组)。     

青光眼小梁切除术中以穹隆为基底结膜瓣两种不同缝合方法的比较

目的观察青光眼小梁切除术中以穹隆部为基底的结膜瓣采用间断缝合和连续锁边缝合两种不同缝合方法的手术效果及并发症。方法双眼原发性青光眼患者20例,左右眼随机分为两组,均施行复合式小梁切除术,采用以窟隆部为基底的结膜瓣。其中一组仅将结膜瓣两角对位间断2针缝合在角膜缘处（以下简称间断组或A组）,另一组将结膜瓣行连续锁边缝合于角膜缘处（以下简称连续组或B组）,形成一密不漏水的密闭腔。观察术后眼压、滤过泡形态及术后并发症等,并进行统计学比较,全部患者均观察至术后6个月。结果两组患者在1个月内眼压控制方面无差异,但结膜切口漏及加压时切口渗漏的并发症间断组明显多于连续组,有统计学差异;术后6个月时眼压控制两组间无统计学差异,但功能性滤过泡的形成连续组优于间断组,两者有统计学差异。结论小梁切除术中以穹隆为基底结膜瓣采用连续缝合对于术后眼压的控制、功能滤泡的形成较间断缝合效果好,而术后结膜切口漏及加压渗漏的并发症少。     

穹隆为基底结膜瓣可调整缝线小梁切除术探讨

目的探讨以穹隆为基底结膜瓣可调整缝线小梁切除术的效果、并发症及适应证。方法我院行抗青光眼手术的患者42例(49只眼)作为试验组,和试验组构成相近的文献报导的以角膜缘为基底可调整缝线小梁毁除术为对照组。试验组做以穹隆为基底结膜瓣可调整缝线小梁切除术,术后随访6-12月,观察眼压、滤过泡、视力、前房深度及并发症。结果眼压、滤过泡、浅前房、前房积血、低眼压、脉络膜脱离等与对照组及有关文献报导无显著差异。但试验组角膜切口轻度渗漏较多。结论以穹隆为基底结膜瓣可调整缝线与以角膜缘为基底结膜瓣可拆除缝线小梁切除术一样有效、安全,但操作更简便、省时。对大于50岁的各型原发性青光眼是适用的。为防止角结膜缘切口渗漏,第一针可调整缝线的拆除时间和眼球指压按摩时间最好在术后6天以后。     

结膜瓣大小对小梁切除术后滤过泡形态及眼压的影响

目的:探讨以穹隆部为基底的不同大小结膜瓣切口对小梁切除术后滤过泡的形态及眼压的影响。方法:选择施行小梁切除术的患者61例66眼,根据结膜瓣大小不同随机分为两组,A组33眼为大结膜瓣(3个时钟范围),B组33眼为小结膜瓣(2个时钟范围),密切随诊观察术后滤过泡的形态及眼压情况。结果:术后功能性滤过泡形成率A组(91%)>B组(73%);眼压控制率A组(94%)>B组(76%)。结论:采用以穹隆部为基底的大结膜瓣可提高小梁切除术后功能性滤过泡形成率,从而能更好地控制眼压。     

巩膜瓣可调整缝线预防小梁切除术后浅前房的作用

目的观察巩膜瓣可调整缝线在预防青光眼小梁切除术后浅前房中的作用。方法对60例(89眼)青光眼患者,在手术显微镜下,做穹隆部或角膜缘为基底结膜瓣,常规的梯形巩膜与小梁切除术。在巩膜瓣两侧做可拆缝线。球结膜切口连续紧密缝合。术后观察眼压、前房深度、结膜滤过泡、眼内组织反应与并发症。当手术后前房形成稳定或眼压回升大于10mmHg时,拆除巩膜调整缝线。术后平均随访时间6个月。结果术后第一天前房形成良好74只眼,术后巩膜瓣缝线松解时间5-30天,平均11天,缝线松解后,结膜滤过泡明显增大。60例患者术后随访眼压3-18mmHg,平均(9.1±2.75)mmHg与术前眼压相比,差异非常显著,所有患者随访中均未应用抗青光眼药物治疗,呈现血管少、弥散而微隆起的功能性结膜滤过泡。结论巩膜瓣可调整缝线能促进青光眼小梁切除术后早期前房的形成,减少前房形成迟缓所致的并发症。有利于小梁切除术后长期滤过作用,提高青光眼手术的安全性和有效性。     

结膜下注入Healon GV对提高滤过泡成功率的作用

目的 观察小梁切除术中结膜下注入Ｈｅａｌｏｎ ＧＶ对滤过泡的影响。方法 急性闭角型青光眼３８例共５０眼,随机分为两组,Ａ组１７例（２５眼）为对照组,常规行角膜缘为基底的结膜瓣下的小梁切除术;Ｂ组１９例（２５眼）,于角膜缘为基底的结膜瓣下的小梁切除术中之滤过部位结膜下注入ＨｅａｌｏｎＧＶ０．１～０．２ｍｌ,术后观察滤过泡、前房、眼压、视力等情况,随访６个月,将滤过泡情况按ｋｒｏｎｆｅｄ标准分型登记,并统计手术成功率。结果 Ａ组Ⅰ型＋Ⅱ型滤过泡占６４％,而Ｂ组占８８％。手术成功率Ａ、Ｂ两组分别为７２％和９２％。术后４、５、６月两组眼压对比有显著性差异。结论 ＨｅａｌｏｎＧＶ球结膜下注射可增加滤过泡的成功率。     

结膜瓣下水囊的形成在复合式小梁切除术中的应用

目的:探讨复合式小梁切除术中结膜瓣下水囊的形成对预测和控制术后滤过量及减少并发症的疗效。方法:186例200眼原发性青光眼随机分为观察组与对照组。观察组行结膜瓣下水囊的形成结合复合式小梁切除术(即可拆缝线、丝裂霉素C和小梁切除术),对照组行复合式小梁切除术。同期进行疗效观察对比。指标包括视力、眼压、滤过泡、前房深度及并发症,随访12mo。结果:术后早期,观察组浅前房、滤过泡渗漏及并发症的发生率明显低于对照组,术后远期,观察组眼压明显低于对照组,视力下降及非功能性滤过的发生率也明显低于对照组。结论:结膜瓣下水囊的形成可有效控制眼压,减少术后滤过泡渗漏、浅前房、恶性青光眼等并发症发生。     

复合式小梁切除术的临床应用体会

目的评价复合式小梁切除术（常规小梁切除术联合巩膜瓣可调节缝线、丝裂霉素C、前房穿刺术、角膜缘球结膜切口连续缝合）治疗青光眼的效果。方法对79例（105只眼）青光眼患者施行复合式小梁切除术。术后检查前房深度、滤过泡情况和眼压。结果术后随访12~72个月,平均33个月。本组病例术后浅前房发生率低,为21.90%,术后早期滤过泡均形成良好,随访眼压控制理想。本组手术成功率高,为84.76%。结论复合式小梁切除术能有效减少青光眼滤过手术后并发症的发生,提高手术成功率。     

结膜瓣切口大小对小梁切除术后滤过泡形成的影响

目的探讨不同大小切口的以穹隆为基底的结膜瓣,对小梁切除术后功能性滤过泡形成的影响。方法选择于我院施行小梁切除术的患者62名68只眼,依据穹隆为基底的“L”形切口结膜瓣的大小不同随机分为三组,A组结膜瓣切口为5mm×10mm,B组结膜瓣切口5mm×7mm,C组为A组基础上辅以角膜缘连续缝合。对术后功能泸过泡进行密切观察随诊,干预治疗,比较三种方法对眼压控制的效果。结果术后滤过道瘢痕形成A、C二组为0,B组31.81%;术后早期滤过过强A组30.40%>B组9.0%>C组8.70%。术后稳定期功能性滤过泡的保存率C组91.30%>A组86.96%>B组63.64%。结论以角膜缘连续缝合的以穹隆为基底的大切口结膜瓣联合调整缝线术可以提高小梁切除术后功能性滤过泡形成率。     

复合小梁切除及术后眼球按摩治疗青光眼

目的观察复合小梁切除及术后中、远期眼球按摩治疗青光眼的临床疗效。方法对观察组34例（36眼）青光眼施行复合小梁切除术,术后中、远期进行眼球按摩;对照组26例（32眼）行标准小梁切除术。观察术后前房形成、眼压及滤过泡情况。结果观察组36眼中2眼形成浅前房,对照组32眼中18眼浅前房,两者比较差异有统计学意义（P〈0．01）;眼压,观察组〉21mmHg者1眼,对照组〉21mmHg者5眼,两者比较差异有统计学意义（P〈0．01）;滤过泡,观察组功能滤过泡明显优于对照组,比较差异有统计学意义（P〈0．01）。结论复合小梁切除及术后中、远期眼球按摩,提高了手术成功率,可有效控制滤过量而减少术后浅前房以及中、远期滤过道瘢痕化等并发症。     

眼球按摩在难治性青光眼滤过手术后的应用观察

目的 观察抗青光眼滤过术后应用眼球按摩的临床效果.方法 对37例难治性青光眼42眼行复合小梁切除术后行眼球按摩患眼,在术后第一天起进行眼球按摩.经测量眼压,观察前房,滤过泡（Seidel试验）,等进行临床分析.结果 37例滤过手术42眼,患者眼压均正常,滤过泡功能良好,前房良好.结论 难治性青光眼滤过术后早期及时发现滤过功能减退的征象及时准确进行眼球按摩,是提高难治性青光眼手术成功率的简单有效的治疗方法.     

Cystic bleb formation and related complications in limbus- versus fornix-based conjunctival flaps in pediatric and young adult trabeculectomy with mitomycin C

OBJECTIVE: Comparison of fornix- and limbus-based conjunctival flaps with respect to cystic bleb-related complications of trabeculectomy with high-dose mitomycin C (MMC) in pediatric and young adult glaucoma. DESIGN: Retrospective nonrandomized comparative interventional case series. PARTICIPANTS: Thirty-seven patients. METHODS: Identification of patients aged <30 years from operating theater records from 1995 and 1996 of the Moorfields Pediatric Glaucoma Service who had trabeculectomy with an MMC concentration of >/=0.4 mg/ml. Over a 2-year period, 37 consecutive operations matching these criteria were performed by a single surgeon: 20 with a limbus-based flap and 17 with a fornix-based flap. Except for the conjunctival incision and associated alteration in antimetabolite application and wound closure, the surgical technique was not significantly different between the groups. MAIN OUTCOME MEASURES: Bleb evolution and complications. RESULTS: The age at time of surgery, MMC concentration, history of one or more previous surgeries, and follow-up were similar in the 2 groups. The risk of cystic bleb formation was greater in the limbus-based flap group (90% in the limbus-based group vs. 29% in the fornix-based group; P<0.001). Late hypotony and bleb-related ocular infection were more common in the limbus-based flap group (P<0.05) and occurred earlier. There were four episodes of bleb-related infection (20%) in the limbus-based group (three of these [15%] were bleb-related endophthalmitis) and none in the fornix-based group. CONCLUSIONS: In pediatric and young adult trabeculectomy with high doses of MMC, limbus-based flaps may be more likely to develop serious bleb-related complications and may develop these earlier than fornix-based flaps. The higher rates of complications could be attributable to the differences in bleb morphology, with limbus-based flap cases more likely to develop cystic blebs.     

Phacotrabeculectomy: limbus-based versus fornix-based conjunctival flaps in fellow eyes.

OBJECTIVE: To compare the effectiveness of limbus-based and fornix-based conjunctival flaps in fellow eyes of the same patients undergoing combined trabeculectomy with phacoemulsification. DESIGN: Prospective, nonrandomized comparative (fellow eye) study. PARTICIPANTS: Forty-four patients and 88 fellow eyes. INTERVENTION: Limbus-based conjunctival flap with phacotrabeculectomy was performed in one eye, and a fornix-based conjunctival flap with phacotrabeculectomy was performed in the fellow eyes of the same patients. The patients were followed up for a minimum of 1 year postoperatively for each eye. MAIN OUTCOME MEASURES: Preoperative and postoperative visual acuity, intraocular pressure, number of antiglaucoma medications, interventions, and complications were studied. RESULTS: At last follow-up visit, visual acuity improved to 20/40 or better in 88.6% of the limbus-based group and 79.6% of the fornix-based group. Preoperatively, the mean intraocular pressure in the limbus-based group was 21.4 +/- 4.8 mmHg on a mean of 2.4 +/- 1.2 glaucoma medications; in the fornix-based group, it was 21.4 +/- 4.3 mmHg on a mean of 2.3 +/- 1.1 medications. Mean intraocular pressure decreased to 15.3 +/- 3.3 mmHg (P < 0.01) on a mean of 0.2 +/- 0.5 glaucoma medications in the limbus-based group (P < 0.01). In the fornix-based group, mean intraocular pressure at last follow-up visit decreased to 15.3 +/- 4.7 mmHg (P < 0.01) on a mean of 0.2 +/- 0.5 medications (P < 0.01). Postoperative interventions and complications were not statistically different between the two groups. CONCLUSION: With phacotrabeculectomy, limbus-based and fornix-based conjunctival flaps are equally effective in improving visual acuity and lowering intraocular pressure. This variation in conjunctival flap orientation was equally effective in fellow eyes of the same patients, with no difference in postoperative complications or outcomes.     

Two-site phacotrabeculectomy with intraoperative mitomycin-C: fornix- versus limbus-based conjunctival opening in fellow eyes

To prospectively compare the influence of fornix-based and limbus-based conjunctival flaps on the final outcome and complications of 2-site phacotrabeculectomy with mitomycin-C in fellow eyes of patients with bilateral open-angle glaucoma (OAG).Glaucoma Unit, Department of Ophthalmology, University of Crete, Crete, Greece.Twenty-two patients with bilateral primary OAG and 8 patients with bilateral exfoliative glaucoma had 2-site phacotrabeculectomy in both eyes. Eyes were randomly assigned to the fornix-based flap or limbus-based flap group by the use of random tables.The intraocular pressure (IOP) decreased significantly in both groups (P <.01); however, there was no statistically significant difference between the groups in the amount of IOP decrease or the number of postoperative antiglaucoma medications after a 1-year follow-up. Faster improvement in visual acuity was observed in the fornix-based group during the first week. The mean time of surgery was 3.5 minutes less in the fornix-based group. An increased incidence of fibrin exudation, pupillary membrane formation, and capsule opacification was found in eyes with exfoliative glaucoma. The early bleb leakage was 3 times more frequent in the fornix-based group.The type of conjunctival flap in a 2-site phacotrabeculectomy did not seem to influence the final outcome. The main advantage of the fornix-based conjunctival flap is the shorter surgical time and the relatively faster improvement in vision postoperatively. The main disadvantage is more frequent early bleb leakage.     

球筋膜下麻醉的复合式小梁切除术治疗青光眼临床观察

目的探讨球筋膜下麻醉进行复合式小梁切除术治疗青光眼临床效果。方法我院连续收入院的128例青光眼患者分为观察组和对照组。观察组65例:球筋膜下麻醉进行以角膜缘为基底的结膜瓣的复合式小梁切除术治疗青光眼;对照组68例:球后麻醉进行以穹窿部为基底的结膜瓣的复合式小梁切除术治疗青光眼,观察患者合作度,眼压、滤过泡形态。结果球筋膜下麻醉组有89.2%的患者术中合作较好,球后麻醉组有88.2%的患者合作比较好或非常好,两组比较差异无统计学意义(P>0.05)。两组术前眼压相似,差异无统计学意义(P>0.05),术后6月眼压:观察组11.42±5.16mmHg,对照组14.12±3.24mmHg,差异有统计学意义(P<0.05)。眼压≤21mmHg为标准,观察组的完全成功率为92.3%。对照组完全成功率为80.9%,两组比较差异有统计学意义(P<0.05)。滤过泡的形态:观察组以弥散型为主,对照组以微小囊泡型为主,两组比较差异有统计学意义(P<0.05)。结论球筋膜下麻醉手术进行中能获得满意的合作度两种类型的结膜瓣形态及降压效果不同。     

青光眼术后滤过泡功能障碍及其治疗的临床探讨

目的探讨青光眼滤过术后滤过泡功能障碍及其治疗。方法对2002年1月至2003年12月我院青光眼滤过手术67例（89眼）进行回顾性分析。结果术后滤过泡功能障碍14例14眼，其中渗漏性滤过泡1眼，滤过泡瘢痕4眼，包裹性滤过泡9眼。此14眼经及时进行药物治疗、眼球按摩及球结膜粘连分离等治疗均使眼压控制在正常水平。结论青光眼术后滤过泡功能障碍及时正确治疗，可提高手术成功率，避免严重并发症。     

完全可拆除调节缝线在小梁切除术中临床应用

目的 探讨完全可拆除巩膜瓣调节缝线在小梁切除术中的临床应用效果.方法 对拟行小梁切除术的青光眼63例（80眼）随机分为两组：观察组（A组）29例（40眼）行完全可拆除巩膜瓣调节缝线的小梁切除术;对照组（B组）34例（40眼）行常规小梁切除术.术后观察前房情况、滤过泡形态、眼压、视力及并发症.随访3～6个月.结果 A组：未拆除调节缝线前无浅前房发生,拆除后发生浅前房7眼（17.5％）,B组浅前房9眼（22.5％）,两组差异无统计学意义（χ2 =2.83,P＞20.05）.功能性滤过泡形成：A组33眼（82.5％）,B组28眼（70.0％）,差异具有统计学意义（χ2=7.65,P＜0.05）.眼压：术后3个月、6个月,A组眼压控制较好,两组眼压下降比较差异具有统计学意义（t=2.536,2.489,P＜0.05）.术后视力：早期A组视力恢复较好,组间差异具有统计学意义（x2=8.94,P＜0.05）.术后两组主要并发症为脉络膜脱离,B组3眼（7.5％）发生角膜缘切口漏.结论 完全可拆除巩膜瓣调节缝线应用于小梁切除术,降低了术后早期并发症,提高了中远期手术疗效.     

青光眼巩膜瓣下蓄水池样小梁切除术的临床研究

目的评价巩膜瓣下蓄水池样小梁切除术治疗青光眼的效果。方法回顾54例（64眼）青光眼的治疗情况。观察组26例（32眼）采用巩膜瓣下蓄水池样小梁切除术;对照组28例（32眼）采用传统小梁切除术。术后随访6个月,观察比较两组术后眼压、滤过泡及并发症情况。结果术后6个月观察组平均眼压为（16.2±4.2）mmHg,对照组平均眼压为（19.8±6.2）mmHg,（P〈0.01）,观察组功能性滤过泡形成率明显高于对照组（P〈0.01）,并发症发生率低于对照组（P〈0.05）。结论巩膜瓣下蓄水池样小梁切除术降压效果、安全性均优于传统小梁切除术,并发症少,是一种较好的抗青光眼手术方式。