再次小梁切除手术眼的临床分析

The clinical analysis of eyes receiving repeated trabeculectomy

目的通过对青光眼滤过手术后眼压不降需要再次手术治疗眼,其手术前后情况的分析,寻找出其临床特点和内在规律,从而更加有效地提高手术成功率。方法对2000～2002年间本中心青光眼专科收治的294例330眼小梁切除术后眼压不降且经药物治疗眼压仍无法控制,而再次接受小梁切除的196例206眼原发性青光眼进行分析。结果手术后眼压不降的294例（330眼）其中原发性青光眼为196例（206眼）,其它类型青光眼共98例（124眼）。初次手术至失败时间为2m至12y不等。330眼的滤过泡的类型分别为：瘢痕化273眼,囊状包裹泡14眼,滤过泡面积太小43眼。再次接受小梁切除的206眼原发性青光眼中156眼获得成功,成功率75.73%,其中完全成功为108眼,条件成功48眼,且这156眼全为功能性滤过泡。结论在接受滤过手术后眼压不降的原发性青光眼中,绝大部分是由于手术质量的原因而致;理想滤过泡的形成是青光眼滤过手术后眼压控制的根本条件;小梁切除仍是再次手术的首选术式。

Objective To find out the clinical feature and internal regularity by analyzing the patients before and after surgeries,who had undergone trabeculectomy, yet needed reoperation because of uncontrollable intraocular pressure（IOP）, thus effectively enhancing the success rate of surgery. Methods 196 cases （206 eyes） receiving repeated trabeculectomy for primary glaucoma,out of the total 294 cases with uncontrollable IOP with even medication after first trabeculectomy between 2000 and 2002 in the glaucoma department at our hospital ,were included in this study. Results In all,there were 294 cases（330 eyes） in hospitalization for uncontrollable IOP after receiving filtering procedure dtLring these 3 years, 196 cases（206 eyes） were primary glaucoma,the other 98 cases（124 eyes） were for other, types of glaucoma. The duration from first-time surgery to failure varied from two months to twelve years.273 eyes had scarring blebs, 14 eyes had encapsulated blebs,and 43 eyes had limited filtering extent. Out of 206 eyes receiving reoperation for primary glaucoma, 156 eyes got success,a rate of 75.73%, 108 eyes in complete success, and 48 eyes in relative success.All of the 156 eyes had functioning blebs .Conclusions Most of the cases with uncontrollable IOP post filtering surgery are caused by surgery quality;formation of functioning bleb is the basic condition in IOP control after filtering procedure;trabeculectomy is still the first choice for reoperation.