可拆式巩膜瓣缝线小梁切除术

Trabeculectomy with removable scleral flap suture

为了解可拆式巩膜瓣缝线是否能有效地减少小梁切除术后并发症。以６５例原发性慢性闭角型青光眼（１０５眼）为对象。前６个月，３４例病人（４８眼）接受标准小梁切除术；后６个月，３１例病人（５７眼）接受可拆式巩膜瓣缝线小梁切除术。术后一天、七天、一月及一年，检查比较两组滤过泡、前房深度、眼压、视力和眼底情况。结果：在可拆式巩膜瓣缝线小梁切除术组，术后早期Ⅱ—Ⅲ度浅前房和视力下降的发生率分别为３．５１％和１０．５３％；而在标准小梁切除术组，为１６．６７％和２９．１７％（Ｐ＜０．０１）。而且，术后前房轴深减少值与术后一天眼压成直线负相关关系。结论：小梁切除术后超滤过是前房形成迟缓和低眼压性黄斑病变的主要原因。可拆式巩膜瓣缝线小梁切除术能有效控制术后滤过水平，从而减少因超滤过所引起的术后并发症。

To determine whether the use of removable scleral flap suture affects the incidence of complications following trabeculectomy.Six ty five consecutive patients (105 eyes) underwent trabeculectomy because of chronic angle closure glaucoma.During the first six months,34 patients(48 eyes) underwent standard trabeculectomy techniques.During the second six months,31 patients(57 eyes) underwent trabeculectomies with removable scleral flap suture.The intraocular pressure,the anterior chamber depth,and the visual acuity were measured and compared for the two groups on day 1,day 7,one month and one year after trabeculectomy.results:The incidences of the Ⅱ—Ⅲ degree shallow anterior chamber and the visual acuity loss were 3 51% and 10 53% in the removable sclera flap suture group,respectively;and the incidences of above two complications were 16 67% and 29 17% respectively,in the standard trabeculectomy group(P<0 01). There was a strong correlation between postoperative intraocular pressure and postoperative anterior chamber depth(r=-0 619,p<0 01).conclusions:Postoperative complications of trabeculectomy,such as shallow anterior chamber,hypotony maculopathy,are mainly associated with overfiltration.Removable scleral flap suture reduces effectively the incidences of the complications related to the overfiltration after trabeculectomy.