巩膜瓣下蓄水池样小梁切除术临床分析

目的探讨巩膜瓣下蓄水池样小梁切除术的临床疗效。方法对26例（32只眼）青光眼患者采用巩膜瓣下蓄水池样小梁切除术,术后观察眼压、滤过泡、并发症及视力,随访6～12个月。结果术后3个月内,32只眼眼压均在正常范围。术后6个月,有1只眼需用1种降眼压药才能使眼压控制在21mmHg以内。滤过泡：功能性滤过泡30只眼,非功能性滤过泡2只眼。并发症：出现浅前房2只眼,其中Ⅰ度1只眼,Ⅱ度1只眼,无Ⅲ度浅前房发生。视力：提高18只眼,不变12只眼,减退2只眼。结论巩膜瓣下蓄水池样小梁切除术引流作用及降眼压效果好,并发症少,值得在临床推广应用。     

巩膜蓄水池样复合式小梁切除术治疗难治性青光眼

目的 探讨巩膜瓣下蓄水池样小梁切除术联合羊膜移植及术中应用丝裂霉素C治疗难治性青光眼的临床效果.方法 将不同类型的难治性青光眼95例(102眼)随机分为2组,观察组48例(52眼)行巩膜蓄水池式小梁切除术联合羊膜植入及术中应用丝裂霉素C和可调整缝线,对照组47例(50眼)行常规的小梁切除术.术后随访4～15个月.结果 术后视力两组间比较差异无统计学意义(x2=1.14,P=0.75).术后2周两组眼压均较其术前为低差异有统计学意义,而组间比较差异无统计学意义(=1.86,P=0.08);术后6个月观察组平均眼压(14.75±3.87 )mm Hg,对照组(19.25±7.14) mm Hg;手术成功率:观察组86.54％,对照组64.00％,观察组成功率较高,两组间差异有统计学意义(x2=3.85,P＜0.05).功能性滤过泡观察组83.0％,对照组61.4％,两组比较差异有统计学意义(x2=5.53,P=0.02).术后观察组出现浅前房较对照组多,治疗后1周均恢复正常.结论 与常规小梁切除术相比,巩膜蓄水池样小梁切除术联合羊膜植入及术中应用丝裂霉素C和可调整缝线治疗难治性青光眼,在防止滤过道瘢痕形成,术后控制眼压等方面有一定优势.     

瓣下蓄水池样小梁切除术联合丝裂霉素C治疗新生血管性青光眼

目的探讨瓣下蓄水池样小梁切除术联合丝裂霉素C治疗新生血管性青光眼的有效方法。方法对24例（33眼）不同原因引起的新生血管性青光眼采用该手术方法，以降低眼压、缓解症状，术后随访2～10个月。结果术后24例（33眼）仅有3眼视力增加，大都保持其原有视力。眼压均控制在20．55mmHg以下，其中，在10～20．55mmHg之间者21眼（63．64％），在6．46～10mmHg之间者9眼（27．27％），低于6．46mmHg者3眼（9．09％）。术后结膜滤过功能良好，未发现包裹性或局限性的无功能滤过泡。结论因各种原因所致的新生血管性青光眼采用本手术方法，可有效控制眼压，解除症状。     

瓣下蓄水池样小梁切除加羊膜植入术治疗难治性青光眼

目的观察瓣下蓄水池样小梁切除加羊膜植入术治疗难治性青光眼的疗效。方法对43例（52眼）难治性青光眼进行瓣下蓄水池样小梁切除加羊膜植入术,术后随访2-10个月,观察术后视力、眼压、滤过泡及其并发症。结果术后眼压大多控制良好,成功率达94.23%;视力除3眼增加外,其余均保持不变;功能性滤过泡为92.31%;并发症以浅前房为主,达25%,前房积血次之,为21.15%。结论因各种不同原因导致的难治性青光眼采用本手术方法,眼压控制良好。     

巩膜瓣下蓄水池样小梁切除术联合羊膜植入、丝裂霉素C治疗难治性青光眼

目的探讨难治性青光眼应用巩膜瓣下蓄水池样小梁切除术联合羊膜植入及应用丝裂霉素C治疗的临床疗效。方法83例（102眼）难治性青光眼进行瓣下蓄水池样小梁切除术,同时联合应用丝裂霉素C、羊膜植入和可拆除调整缝线。术后随访4～28个月,平均15个月。结果视力：有7眼视力较术前提高,90眼视力无变化,5眼视力下降（P〉0．05）。眼压：术前（34．48±6．35）mMHg,术后（14．23±4．57）mmHg（P〈0．01）。滤过泡：全部病例出现功能性滤过泡95眼,非功能性滤过泡7眼。结论瓣下蓄水池样小梁切除术联合羊膜植入、丝裂霉素C、可拆除调整缝线治疗难治性青光眼能有效降低眼压,进而保护视功能。     

无巩膜缝线小梁切除术治疗青光眼的临床研究

目的:探讨无巩膜缝线小梁切除术治疗青光眼的临床效果。方法:选取2007-12/2010-06于我院治疗的各型青光眼45例57眼,随机分为两组,观察组24例29眼采用无巩膜缝线小梁切除术(联合滤过道及结膜下注入适量HealonGV),对照组21例28眼并与同期行常规小梁切除术。观察两组术后眼压、前房、滤过泡及并发症情况。结果:术后随访3～30mo,观察组眼压控制率和功能性滤过泡形成率均高于对照组(P<0.05),并发症发生率低于对照组(P<0.05)。结论:无巩膜缝线小梁切除术(联合滤过道及结膜下注入适量Healon GV)是治疗青光眼的一种有效方法。     

改良巩膜瓣小梁切除术

目的　探讨改良巩膜瓣小梁切除术的效果。方法　 96眼原发性闭角型青光眼分为 2组 ,改良组 40例 43眼行改良巩膜瓣小梁切除术 ,对照组 48例 5 3眼行常规小梁切除术 ,观察两组术后浅前房、眼压及滤过泡等情况。结果　浅前房发生率改良组 4 65 % ( 2 /4 3 ) ,对照组 2 0 75 % ( 11/5 3 ) ,两组比较差异有显著性意义 (P <0 .0 5 ) ;眼压控制在 2 1mmHg以下者改良组42眼 ,对照组 45眼 ,两组比较差异有显著性意义 (P <0 .0 5 ) ;Ⅰ、Ⅱ级功能性滤过泡改良组 40眼 ,对照组 40眼 ,两组比较差异有显著性意义 (P <0 .0 5 )。结论　改良巩膜瓣小梁切除术可明显降低术后浅前房的发生率 ,并能理想地控制眼压。     

小梁切除术联合内巩膜切除治疗青光眼临床研究

目的：分析小梁切除术联合内巩膜切除治疗青光眼的远期效果及早期并发症。方法：对青光眼患者102例122眼行小梁切除术联合内巩膜切除,对术后早期前房深度、术后眼压及术后远期滤过泡形态进行回顾性分析。结果：术后第1、3、6d,分别发生浅前房50.8%、44.3%、4.1%;术后随访12mo,眼压控制正常率为89.3%,术后功能性滤过泡占86.9%。结论：小梁切除术联合内巩膜切除是一种治疗青光眼的有效方法,治疗效果优于传统小梁切除术,虽然术后早期浅前房发生率偏高,但进行适当处理后对手术后远期效果并无影响。     

隧道刀制作巩膜瓣的青光眼小梁切除术临床观察

目的　探讨隧道刀制作巩膜瓣的青光眼小梁切除术临床疗效。方法　采取随机分组法 ,将 49例 ( 63只眼 )原发性闭角型青光眼分为治疗组 2 4例 ( 3 0只眼 )和对照组 2 5例 ( 3 3只眼 ) ,前者为隧道刀制作巩膜瓣的青光眼小梁切除术 ,后者为常规青光眼小梁切除术。随访 12个月。结果　术后 1年 ,治疗组与对照组对比 ,视力有显著差异 (χ2 =4.5 8,P <0 .0 5 ) ;功能性滤过泡经 t检验 ,有显著差异 ( t=3 .88,P <0 .0 5 )。治疗组的完全成功率和条件成功率分别为 90 .2 3 %和 97.3 6% ,对照组的完全成功率和条件成功率分别为 76.8%和 83 .2 7% ,两组有显著差异 ( u=2 .3 6,P <0 .0 5 )。结论　隧道刀制作巩膜瓣的青光眼小梁切除术显著延长了滤过泡的功能 ,有效降低了眼压 ,术后并发症少     

Comparison of standard trabeculectomy versus microtrabeculectomy as a surgical treatment for glaucoma: a randomized clinical trial

Background: To determine the effect of scleral flap size on the medium‐term intraocular pressure control and complication rates after augmented trabeculectomy. Design: Prospective randomized clinical trial. Participants: Glaucoma patients undergoing primary trabeculectomy. Exclusion criteria included previous ocular surgery apart from cataract surgery, secondary glaucoma and age under 18. Methods: Patients were randomized to either standard trabeculectomy (4 × 4 mm scleral flap) or microtrabeculectomy (2 × 2 mm scleral flap), both with adjustable sutures and antimetabolites. Bleb needling was performed as required. Patients were evaluated at day 1, weeks 1, 3, 6 and months 3, 6, 12, 18 and 24 postoperatively. Main Outcome Measures: Vision, intraocular pressure, complications and failure (intraocular pressure ≥ 21 mmHg or not reduced by ≥20% from baseline, intraocular pressure ≤ 5 mmHg, repeat glaucoma surgery and no light perception vision). Results: Forty‐one patients were recruited; 20 had standard trabeculectomy, and 21 had microtrabeculectomy. At 2 years, the mean intraocular pressure and cumulative probability of failure was 12.4 ± 4.6 mmHg and 0.28 for standard trabeculectomy, and 11.5 ± 3.6 mmHg and 0.27 for microtrabeculectomy (P = 0.50 and 0.89, respectively). One patient in each group required Baerveldt device implantation. Vision reduced ≥2 Snellen lines in 15% in the standard trabeculectomy group and 25% in the microtrabeculectomy group, mainly from cataract (P = 0.48). Conclusion: Both trabeculectomy techniques achieved good intraocular pressure reduction and had similar complication rates. Scleral flap size had no significant effect on medium‐term intraocular pressure control and complication profile.     

高眼压状态下的复合式小梁切除术

目的 研究闭角型青光眼持续高眼压状态下复合式小梁切除术的临床效果。方法 对15例16眼眼压控制不良的闭角型青光眼进行了前房穿刺联合复合式小梁切除术。结果16眼手术顺利，无脉络膜下爆发性出血等术中并发症发生；术后随访5～12月，12例(13眼)眼压控制在6～21mmHg(1mmHg=0．133kPa)，其中1眼需局部加用降眼压药物。手术成功率81．25％。3眼出现低眼压(≤5mmHg)发生率18．75％。16眼均为功能性滤过泡，其中5眼为薄壁泡，发生率31．25％。结论 持续高眼压状态下的闭角型青光眼运用复合式小梁切除术是安全有效的。     

细胞骨架作用剂抗青光眼的研究进展

细胞骨架与细胞的各种活动和功能密切相关。在细胞外基质的参与下，细胞骨架调控着房水流出通道的解剖学构架，从而影响小梁网的滤过功能。研究表明，细胞骨架作用剂，如利尿酸、latrunculins、细胞松弛素、某些蛋白激酶抑制剂（H-7、HA1077、Y-27632）、blebbistatin、他汀类药物和BDM均可增加房水流出易度。目前的研究正在致力于探讨细胞骨架作用剂调节房水流出的机制。种种迹象表明，细胞骨架作用剂有可能成为有潜力的抗青光眼药物。     

Ahmed引流阀植入治疗多次小梁切除术失败后的难治性青光眼

目的：观察 Ahmed 青光眼引流阀植入治疗经多次(≥2次)小梁切除术失败后的难治性青光眼的疗效及安全性。方法：对36例36眼经多次小梁切除术后眼压仍失控的患者行 Ahmed 青光眼引流阀植入术,观察手术前后眼压、最佳矫正视力以及术后并发症。所有患者至少随访12mo。结果：术前平均眼压为35.20依7.28mmHg,术后1、2wk,1、3、6、12mo 平均眼压分别降至10.15依3.34、11.23依3.56、15.63依5.72、17.17依5.47、17.73依6.23、19.76依5.43mmHg,与术前眼压相比差异均有统计学意义( t =12.643、11.837、10.324、8.839、8.462、8.046,均 P <0.05)。术后1a 的视力与术前比较无统计学差异(Z =-0.420,P>0.05)。术后1a 时完全成功率为78%,条件成功率为92%。术后早期并发症主要为浅前房、低眼压以及前房积血,经过治疗均自行恢复,晚期并发症为引流管暴露和滤过泡包裹,1例患者出现严重的角膜内皮失代偿。
　　结论：Ahmed 青光眼引流阀植入治疗多次小梁切除术后失败的难治性青光眼是一种有效的方法,但应充分认识并预防各种术后并发症的发生。     

Can early postoperative intraocular pressure predict success following mitomycin-C augmented trabeculectomy in primary angle-closure glaucoma

Purpose

To evaluate the association between early and late postoperative intraocular pressure (IOP) and determine if early postoperative IOP can predict the surgical outcome.

Methods

A total of 165 consecutive patients with primary angle-closure glaucoma (PACG) undergoing primary mitomycin-C-augmented trabeculectomy underwent a comprehensive eye examination before surgery and were followed-up on days 1, 7, 14, and 30, and months 3, 6, 12, and 18. IOPs on days 1, 7, 14, and 30 were stratified into groups A (<10 mm Hg), B (≥10 and <15 mm Hg), C (≥15 and <20 mm Hg), and D (≥20 mm Hg). Differences between groups were analyzed using analysis of variance (ANOVA) and Fisher''s exact test. Multivariable regression was used to exam the predictive ability of early IOP for final outcome.

Results

The mean age was 62.5±7.9 years and 41.21% (n=68) were males. Stratified by IOP on days 1, 7, 14, and 30, respectively, mean IOPs at month 18 were different among groups A, B, C, and D (ANOVA, P=0.047, P=0.033, P=0.008, and P<0.001, respectively). Once the IOPs were settled with interventions on day 7 a higher IOP level was associated with decreasing success rate under different outcome definitions, final IOP <15 mm Hg (Fisher''s exact P=0.001) and <20 mm Hg (P=0.039) without medication. Multiple regression showed early IOP predicted final IOP independently from baseline variables. A cutoff value of 13.5 mm Hg on day 7 achieved an accuracy of 80.0 and 57.1% in predicting IOP<15 mm Hg without medication and failure after surgery, respectively.

Conclusions

The IOP at 18 months following primary antifibrotic-augmented trabeculectomy in PACG patients is associated with and predicted by the postoperative IOPs at 1 month. Control of early IOP to 13.5 or less may provide better outcomes.     

青光眼滤过术后滤过泡的观察方法

青光眼滤过术以其良好的控制眼压效果和较少的术后并发症成为临床上常用的抗青光眼手术方式之一。术后眼压的良好控制均依赖于建立和长期维持有功能的滤过泡。因此对术后滤过泡的形态、演化过程及其与临床功能间关系的研究就显得尤为重要。本文就滤过泡形态方面的相关问题做一综述。     

复合式小梁切除术治疗闭角型与开角型青光眼的对比研究

目的：比较研究复合式小梁切除术在闭角型青光眼(angle closure glaucoma, ACG )及开角型青光眼( open angle glaucoma,OAG)中的治疗效果。
　　方法：前瞻性研究。选择2014-07/2015-07的136例136眼青光眼患者为研究对象,根据青光眼类型分为 ACG 组72例72眼与 OAG 组64例64眼,均给予复合式小梁切除术,比较两组患者术后眼压、浅前房、功能性滤泡以及并发症情况。
　　结果：术后1、3mo,两组眼压均明显下降,ACG 组患者眼压明显低于 OAG 组(t =11.037、12.660, P<0.05);术后3mo时,ACG 组患者眼压控制率98.6%明显高于 OAG 组89.1%(χ2=5.580, P <0.05);ACG 组浅前房总发生率11.1%明显低于 OAG 组25.0%(χ2=4.497,P <0.05);ACG 组功能性滤泡形成率62.5%明显高于 OAG 组43.5%(χ2=4.035,P<0.05);两组并发症发生率比较无统计学意义(5.6% vs 7.8%,P=0.475>0.05)。
　　结论：复合式小梁切除术有助于降低 ACG、OAG 型青光眼患者眼压,安全性高,且 ACG 型青光眼的治疗效果优于OAG 型青光眼。     

Healaflow在青光眼小梁切除术中的应用

目的观察评估网状透明质酸钠Healaflow在原发性闭角型青光眼小梁切除术中应用的临床效果。方法回顾性研究,选取2010年1月至5月间在我院行小梁切除联合Healaflow植入术的原发性闭角型青光眼患者20例24眼作为治疗组,选取同期行小梁切除术的原发性闭角型青光眼患者23例26眼作为对照组,对比观察两组术后不同时间点的视力、眼压、滤过泡形态、前房反应及并发症的发生情况。术后随访18个月。结果术后末次随访时两组视力变化情况差异均无统计学意义(均为P>0.05);术后12个月时,治疗组无需按摩或不用降眼压药物眼压≤21mmHg(1kPa=7.5mmHg)者22眼,占92%,对照组19眼,占73%,两组比较差异有统计学意义(χ2=4.533,P=0.033)。术后18个月时治疗组、对照组分别有1眼、7眼出现非功能性滤过泡,两组比较差异有统计学意义(χ2=4.809,P=0.028)。两组术后各有2眼发生浅前房,无前房出血、睫状体或脉络膜脱离、恶性青光眼等并发症发生。结论青光眼小梁切除术中网状透明质酸钠Healaflow的应用有利于术后功能性滤过泡的形成,能够有效提高中远期手术成功率。     

Course of exfoliation and simplex glaucoma after primary trabeculectomy

AIM: To study the course of exfoliation and simplex glaucoma with respect to intraocular pressure (IOP) regulation and visual field survival after primary trabeculectomy. METHODS: Postoperative IOP regulation and complications were analysed prospectively in 95 patients. Mean follow up was 46 months. Visual field survival was studied by high pass resolution perimetry (HRP) in a subsample of 28 patients. RESULTS: Medical treatment was reinstated in 42% of exfoliation and in 36% of simplex glaucoma. In these patients, mean medicine free survival time, last untreated IOP, and mean IOP at the end of follow up were similar for both glaucoma types. Among patients with controlled postoperative IOP without added medication, mean IOP at the end of follow up was significantly lower in exfoliation glaucoma. Visual field deterioration and the pattern of complications were similar for both glaucoma types. CONCLUSION: The effect of trabeculectomy on IOP regulation was good in both types of glaucoma, and somewhat better in exfoliation glaucoma. The magnitude of IOP lowering could not separate patients with continued visual field deterioration from those in whom visual fields remained stable. Visual field preservation was similar for both glaucoma types.     

活动期葡萄膜炎性青光眼患者接受小梁切除术后的炎症反应及眼压情况

目标:分析活动期葡萄膜炎患者在小梁切除术后的炎症反应及眼压情况.方法:我们回顾了2006-10/2011-03期间,接受了小梁切除术的活动期葡萄膜炎性青光眼患者纪录.手术前后的炎症反应、复发频率、类固醇依赖度及眼压均以配对t检验作比较.结果:在29例29眼患者中,90％的患眼在手术时正在接受局部类固醇治疗.患者平均年龄为58.3±14.0a,术前眼压为35.7±8.9mmHg.患者平均复诊时期为35.2±18.7mo.术后3mo前房炎症反应分级平均减少了0.4±0.6(P＜0.01).复发频率在复诊期内每年减少了2.3±2.1次(P＜0.01).术后1a的平均眼压为13.1±4.5mmHg,而其中44.8％患者的眼压无需用药亦能维持在21 mmHg或以下.结论:小梁切除术后的葡萄膜炎性青光眼患者在炎症反应及眼压方面均有改善,但成功率较原发性青光眼患者低.小梁切除术可以作为活动期葡萄膜炎性青光眼患者早期控制眼压和炎症反应治疗的一个选择.