小梁切除改良术式治疗青光眼的远期疗效观察

目的:探讨小梁切除术中改良巩膜瓣的制作方法,观察术后远期疗效。方法:对50例85眼不同类型的青光眼行小梁切除(观察组),术中制作隧道式4mm×6mm巩膜瓣,巩膜瓣的后缘与巩膜床间作三针跨度为4mm的闭合式缝合,对照组50例82眼行常规小梁切除术。结果:术后平均随访8～30mo。视力:观察组有7眼较术前提高,5眼视力下降,其余视力无明显变化,差异无统计学意义。眼压:观察组术后末次随访平均眼压与术前平均眼压比较,差异有统计学意义(P<0.05)。视盘参数:观察组视乳头盘沿面积(RA,m2)、盘沿体积(RV,mm3)、平均神经纤维层厚度(mRNFL,mm)与术前比较有改善,差异有统计学意义(P<0.05)。视野:观察组5眼视野较术前扩大,3眼视野缩小,其余视野无明显变化。与对照组比较: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:改良式小梁切除术,术后远期眼压控制效果明显,并发症少,可改善视功能,是一种安全有效的手术方法。     

改良小梁切除与传统小梁切除的远期效果观察

目的评价小梁切除术中改良巩膜瓣、睫状突定量小梁切除、不同缝合方式在术中术后的优缺点及远期效果。方法120例(156眼)原发性青光眼随机分为4组:A组(传统术式组)30例(42眼);B组(可拆褥式缝线组)30例(40眼);C组(L形巩膜瓣小梁切除组)30例(34眼);D组(小切口睫状突定量小梁切除术组)30例(40眼),B,C,D组为改良术式组。比较各组术后浅前房、眼压和滤过泡情况。结果浅前房发生率:A组26.19%(11/42),B组7.50%(3/40),C组2.94%(1/34),D组2.50%(1/40),改良术式组与传统术式组比较差异有统计学意义(P<0.01);随诊眼压:A组(14.65±4.30)mmHg,B组(13.87±3.60)mmHg,C组(15.58±3.20)mmHg,D组(14.50±3.15)mmHg,4组间差异无统计学意义(P>0.05);随诊功能性滤过泡A组76.19%(32/42),B组92.50%(37/40),C组97.05%(33/34),D组95.00%(38/40),传统小梁切除组与改良小梁切除组比较差异有统计学意义(P<0.05)。结论采用巩膜瓣可拆褥式缝线、L形巩膜瓣小梁切除、小切口睫状突定量小梁切除可大大降低术后浅前房的发生率,并能理想地控制眼压,提高术后视功能。     

改良巩膜瓣小梁切除与传统小梁切除的疗效观察

目的　了解小梁切除术中改良巩膜瓣、不同缝合方式在术中、术后的优缺点。方法　 90例 116眼青光眼患者随机分为 3组 :传统术式组 30例 4 2眼 ;可拆褥式缝线组 30例 4 0眼 ;L形巩膜瓣小梁切除组 30例 34眼。比较 3组术后浅前房、眼压和滤过泡情况。结果　浅前房发生率传统术式组 2 6 18% ,可拆褥式缝线组 7 5 % ,L形巩膜瓣切除组2 94 % ,改良巩膜瓣组与传统术式组比较有非常显著性差异(P <0 0 1) ;随诊眼压传统术式组 (14 6 5± 4 30 )mmHg(1kPa =7 5mmHg) ,可拆褥式缝线组 (13.87± 3.6 0 )mmHg ,L形巩膜瓣切除组 (15 .5 8± 3.2 0 )mmHg ,3组间差异无显著性 (P >0 0 5 ) ;随诊功能性滤过泡传统术式组 76 % ,可拆褥式缝线组 93% ,L形巩膜瓣切除组 96 % ,传统小梁切除组与改良巩膜瓣小梁切除组比较差异有显著性 (P <0 .0 5 )。结论　采用巩膜瓣可拆褥式缝合与L形巩膜瓣小梁切除可大大降低术后浅前房的发生率 ,并能理想地控制眼压 ,提高术后视功能     

前部视网膜冷凝联合小梁切除术治疗新生血管性青光眼的远期疗效观察

目的 探讨前部视网膜冷凝联合小梁切除术治疗新生血管性青光眼的远期疗效.方法 对38例(38眼)新生血管性青光眼行前部视网膜冷凝联合小梁切除术,术中使用丝裂霉素C(0.4 g·L-1).观察术后1个月、3个月、6个月、1 a、3 a、6a的眼压、视力及中晚期并发症情况.结果 术后1个月、3个月、6个月、1 a、3 a、6 a的眼压控制率分别为100％、97.37％、92.11％、84.21％、82.26％、82.35％;术后1个月眼压控制率与3个月、6个月比较,差异均无统计学意义(均为P＞0.05);3个月与6个月比较,差异无统计学意义(P＞0.05),但3个月与1 a、3 a、6 a之间比较,差异均有统计学意义(均为P＜0.05);6个月与1 a、3 a、6 a之间比较,差异均无统计学意义(均为P ＞0.05);1a、3 a、6a之间比较,差异无统计学意义(P＞0.05).术后1个月、3个月、6个月时38例中均有12例视力较术前提高,无视力下降者;术后1 a时38例中10例视力较术前提高,2例下降;术后3a时29例中6例视力较术前提高,4例下降;术后6a时17例中3例视力较术前提高,5例下降.术后并发症主要是黄斑水肿、黄斑变性、黄斑出血和白内障等.结论 前部视网膜冷凝联合小梁切除术治疗新生血管性青光眼,经长期随访证明大部分患者能有效安全控制眼压,部分患者可提高视力,且远期疗效稳定.     

改良小梁切除术治疗青光眼的远期疗效

目的对改良小梁切除术治疗各类青光眼的远期疗效进行临床研究,并评估此术式的远期效果。方法回顾性分析1980-1990运用改良小梁切除术治疗各类青光眼118例(156眼),其中闭角型青光眼128眼,开角型青光眼11眼,继发性青光眼9眼,先天性青光眼8眼,并自拟定Ⅰ-Ⅳ级疗效标准。结果经7～10a的随访观察,术后1、2、3、5、10a手术成功率分别为92.3％、90.1％、87.3％、80.4％、78.3％。远期并发症:并发白内障10眼(6.4％),瘢痕粘连眼压升高20眼(12.8％)。结论长期随访观察及临床研究显示改良小梁切除术设计合理、操作简便安全可靠,并发症少,疗效满意,易于推行。     

改良式小梁切除术治疗青光眼的疗效观察

目的探讨改良式小梁切除术联合丝裂霉素C治疗青光眼的临床疗效。方法应用改良式小梁切除术治疗42例(64眼)各型青光眼,术中一次性使用0.4mg/ml丝裂霉素C,术后随访6～12月,观察其临床疗效及其并发症。结果术后1月检查,58眼(90.6%)术后视力有不同程度的提高;术后1周测眼压,所有病例眼压均有不同程度的下降,有48眼(75.0%)眼压低于21 mmHg,术后6月测眼压,54眼(84.6%)低于21 mmHg;末次随访时,56眼(87.5%)形成弥散扁平的功能性滤过泡,8眼(12.5%)为非功能性滤过泡;总手术成功58眼(90.6%),其中完全成功54眼(84.4%),条件成功4眼(63%),失败6眼(9.4%)。术后主要并发症为:角膜水肿5眼,前房渗出4眼。讨论改良式小梁切除术联合丝裂霉素C治疗青光眼,可有效地减少青光眼术后滤过道瘢痕的形成,充分降低眼压。该方法不需要特殊设备,手术时间短、损伤小,并发症少,手术效果好,是一种安全、有效的治疗青光眼方法。     

改良的小梁切除联合晶状体超声乳化术疗效分析

目的 回顾性分析改良的小梁切除术联合晶状体超声乳化术的临床效果.方法 2005年1月至2008年4月进行改良的小梁切除联合超声乳化术79例(95眼).手术由同一术者施行,手术采用单一巩膜隧道切口小梁切除术联合晶状体超声乳化术.记录术后第1天、1周、1个月、3个月、1年及最后一次随访时的最佳矫正视力、眼压及并发症.结果 平均随访(16.9±7.2)个月.术前平均视力为0.25 ±0.27,术前平均眼压为(20.1±7.3)mm Hg;术后1d、1周、1个月、3个月、1年及最后一次随访时的眼压依次为(16.3±9.2)mm Hg、(12.3±4.2)mm Hg、(14.8±5.2)mm Hg、(15.1±3.1)mm Hg、(14.8±2.7)mm Hg、(14.5±2.8)mmHg,不同时期眼压与术前相比差异具有统计学意义(P＜0.05).术后1年的最佳矫正视力为0.74±0.34,与术前相比差异具有统计学意义(P＜0.05).术后浅前房发生率为6.3％(6/95),平均持续时间为(6.5±3.8)d;术后脉络膜脱离的发生率为11.6％(11/95);术后需要辅助5-氟尿嘧啶局部注射者占41.1％(39/95),平均注射次数(3.5±4.2)次;27.4％(26/95)的术眼需要应用1种以上局部降眼压药物治疗.1年时的手术成功率为93.7％(89/95),完全成功率为66.3％(63/95).结论 单一巩膜隧道切口小梁切除联合晶状体超声乳化术可以明显减少手术创伤、缩短手术时间,但术后早期需密切观察,联合局部抗代谢药物注射,随访期内手术效果好,远期疗效需进一步继续随访.     

改良式小梁切除联合深层巩膜切除术

小梁切除术一直是最为经典的抗青光眼手术,也是适应证最广、降眼压幅度最大的外滤过性手术代表。根据小梁切除术的降眼压机制及其术式改良的演变与发展,本文在既往各种术式改良的基础上,总结了一种较为优化的术式——小梁切除联合深层巩膜切除术。此术式发挥了多种引流机制、降眼压幅度大、可有效避免滤过泡相关远期并发症;手术适应证与小梁切除术相同,更适合于中晚期青光眼患者;操作简单、易学;术后并发症相对较少。(眼科,2022,31:175-180)     

视网膜断层扫描仪对正常人群视乳头形态结构参数的测定

目的 了解正常人群视乳头形态结构参数的正常值。方法 用海德堡视网膜断层扫描仪(Heidelberg retina tomography，HRT)系统对排除眼病的200只眼进行检查，按年龄分成5组，得出不同年龄人体视乳头参数的数值。结果 应用HRT系统提供的视乳头各类参数，主要有视盘面积(disk area)、视杯面积(cup area)、杯盘面积比(cup／disk area ratio)、盘缘面积(rim area)、视杯体积(cup volume)、盘缘体积(rim volume)、平均视杯深度(mean cup depth)、最大视杯深度(maximum cup depth)、视杯形状测定(cup shape measure)、轮廓线高度变化(height vari—ation contour)、平均视网膜神经纤维厚度(mean RNFL thickness)、视网膜神经纤维截面面积(RNFL cross section area)，通过统计分析，5组数值视杯面积、盘缘体积、轮廓线高度变化、平均视网膜神经纤维厚度、视网膜神经纤维层截面面积在49岁以下与50岁以上有显著差异，而49岁以下各组之间无明显差异。结论 通过比较该组数据，较以往欧美所提供的数据有所不同，该组数据较以往国内参考值亦有差别。     

Impact of application of bio-amniotic membrane immersed in 5-fluorouracil solution in trabeculectomy on rabbit retina

Background:

To observe the impact of application of bio-amniotic membrane immersed in 5-fluorouracil solution in trabeculectomy on the retina in a rabbit model.

Materials and Methods:

Healthy white New Zealand rabbits were randomly assigned into three groups with 20 in each group. Bio-amniotic membranes of 4 × 5 mm immersed in either physiological saline/water for 10 min, or 25 mg/mL 5-fluorouracil solution for 5 and 10 min, respectively, were applied on rabbit eyes during trabeculectomy. At 7, 14, 21, and 28 days of postoperation, five rabbits from each group were examined with electroretinogram (ERG). After being examined for eye pressure and bleb morphology, rabbits were sacrificed by air embolism and their retinas were collected and examined by transmission electron microscopy (TEM). In addition, 5-fluorouracil amount in bio-amniotic membranes was measured using high-performance liquid chromatography.

Results:

Each bio-amniotic membrane could absorb 59.004 μg and 75.828 μg 5-fluorouracil after being immersed in 5-fluorouracil solution for 5 and 10 min, respectively. Application of these bio-amniotic membranes in trabeculectomy could promote the formation of well-functioning bleb and maintain intraocular pressure, although it had no effect on retina structures as examined with ERG and TEM.

Conclusion:

Application of 5-FU soaked bio-amniotic membrane in rabbit eye trabeculectomy is effective and safe.     

改进的结膜瓣转位术治疗翼状胬肉的临床观察

目的评价改进翼状胬肉的手术方法降低复发率的效果。方法原发性翼状胬肉60例（78眼）,在手术显微镜下广泛切除变性的眼球筋膜囊组织联合自体舌形球结膜瓣转位修复方法,以最小的手术损伤,尽可能修复角膜缘上皮（干细胞）的屏障功能。结果术后随访12～24个月,平均18个月,2眼复发（2．56％）,视力明显提高。结论作者设计的改进显微手术切除联合舌形球结膜瓣转位术,手术操作简单,术后复发率低。     

复合式小梁切除术的临床疗效观察

目的:评价复合式小梁切除术的疗效。方法:对2003-03/2006-12收治的128例(152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。随访时间4~18mo。结果:本组病例术后浅前房发生率5.9%(9眼),保持功能性滤过泡者93.4%(142眼),以眼压≤20.6mmHg为手术成功标准,手术成功率89.5%。无渗漏、感染。结论:复合式小梁切除术可以调节房水滤过量,减少并发症发生,提高手术成功率。     

Optic nerve head parameters of high-definition optical coherence tomography and Heidelberg retina tomogram in perimetric and preperimetric glaucoma

Background:Heidelberg retina tomogram (HRT) and optical coherence tomography (OCT) are two widely used imaging modalities to evaluate the optic nerve head (ONH) in glaucoma.Purpose:To compare the ONH parameters of HRT3 and high-definition OCT (HD-OCT) and evaluate their diagnostic abilities in perimetric and preperimetric glaucoma.Design:Cross-sectional analysis.Methods:35 control eyes (24 subjects), 21 preperimetric glaucoma eyes (15 patients), and 64 perimetric glaucoma eyes (44 patients) from the Longitudinal Glaucoma Evaluation Study underwent HRT3 and HD-OCT examinations.Results:Optic disc area, vertical cup to disc ratio, and cup volume with HD-OCT were larger than with HRT, while the rim area was smaller with HD-OCT (P < 0.001 for all comparisons). AUCs of all HD-OCT ONH parameters (0.90-0.97 in perimetric and 0.62-0.71 in preperimetric glaucoma) were comparable (P > 0.10) to the corresponding HRT ONH parameters (0.81-0.95 in perimetric and 0.55-0.72 in preperimetric glaucoma). LRs associated with diagnostic categorization of ONH parameters of both HD-OCT and HRT were associated with larger effects on posttest probability of perimetric compared to preperimetric glaucoma.Conclusions:ONH measurements of HD-OCT and HRT3 cannot be used interchangeably. Though the diagnostic abilities of ONH parameters of HD-OCT and HRT in glaucoma were comparable, the same were significantly lower in preperimetric compared to perimetric glaucoma.     

Effect of trabeculectomy on RNFL thickness and optic disc parameters using optical coherence tomography

Purpose

To study the change in retinal nerve fibre layer (RNFL) thickness and optic nerve head (ONH) parameters using optical coherence tomography (Stratus OCT 3) after trabeculectomy in adult patients with glaucoma.

Methods

A total of 17 patients with glaucoma undergoing trabeculectomy were recruited. Average and quadrant RNFL thickness measurements, vertical integrated rim area, horizontal integrated rim width, disc area, cup area, and rim area were measured using Stratus OCT within a week before surgery and at 1 week, 1 and 3 months postoperatively. Main outcome measures were change in RNFL and ONH parameters. Pre- and postoperative values were analysed using the Wilcoxon signed-rank test.

Results

Intraocular pressure (IOP) reduced from 30.23±9.02 mm Hg preoperatively to 9.52 ±2.42 mm Hg at 1 week, 12.35±4.59 mm Hg at 1 month, and 13.6 ±2.31 mm Hg at 3 months after trabeculectomy. A significant increase in average (P=0.019) and inferior RNFL (P=0.038) thickness was observed 1 week after surgery. At 3 months postoperatively, they had reverted to preoperative values. RNFL thickness change had no correlation with IOP change. Mean optic disc cup area decreased from 2.39±0.52 mm² preoperatively to 2.14±0.52 mm² at 1 week (P=0.022), 2.22±0.53 mm² at 1 month (P=0.038), and 2.27±0.60 mm² at 3 months (P=0.071). No significant change was found in other ONH parameters.

Conclusions

Short-term fluctuations were noted in RNFL thickness and ONH postoperatively following glaucoma filtration surgery. RNFL thickness temporarily increased and cup area decreased but the values reverted to normal within 3 months.     

复合式小梁切除术治疗难治性青光眼的术后观察及处理对手术疗效的影响

目的 评估对难治性青光眼采用复合式小梁切除术,术后细致的观察及相应的处理对远期手术疗效的影响.方法 55例(58眼)难治性青光眼行复合性小梁切除术,包括术中应用丝裂霉素C,对新生血管性青光眼术中虹膜新生血管电凝,加用自行设计的可拆除巩膜缝线等,术后观察前房形成、眼压及滤过泡,并根据观察结果选择拆线时间,及加用抗瘢痕药物治疗,术后随访5-30个月,平均随访(20.03±6.79)月.结果 出院时眼压在6-12 mmHg之间(1 mmHg=0.133kPa).术后6月,87.93%(51/58)的眼平均眼压(12.5±5.7)mmHg,并形成功能性滤过泡.末次随访眼压在不用药的情况下,84.48%(49/58)的眼眼压在20 mmHg以下.结论 复合式小梁切除术,细致的术后观察及相应的处理可提高难治性青光眼手术的远期效果.     

复合小梁切除治疗原发性青光眼的临床观察

摘 目的观察复合小梁切除术治疗原发性青光眼的疗效和并发症。方法选择住院确诊原发性青光眼需要行滤过手术的58例（76眼），随机分为A组实验组（复合小梁切除术）43眼和B组对照组（常规小梁切除术）33眼。比较两组术后前房形成、眼压、滤过泡情况及并发症。结果A组发生浅前房2眼，B组发生9眼。A组和B组平均眼压术后2周为12．7mmHg和13．6mmHg，术后6月为17．6mmHg和20．8mmHg；两组术后功能性滤泡分别为36眼和27眼；且A组术后并发症发生率明显低于B组。结论复合小梁切除术手术并发症少，手术成功率及安全性高。