改良巩膜瓣可拆除缝线法在急性闭角型青光眼小梁切除术中的应用

Clinical observation of an improved suture method of scleral flap in trabeculectomy of acute angle-closure glaucoma

目的:观察一种改良式巩膜瓣可拆除缝线法在急性闭角型青光眼小梁切除术中的临床效果。方法:对16例28眼急性闭角型青光眼患者施行小梁切除联合虹膜周边切除术,术中对巩膜瓣采取改良式可拆除缝合。结果:所有患者随访6～12(平均8.7)mo。可拆除缝线拆线时间3～17(平均8.33)d,拆线前眼压12.23～18.86(平均15.25)mmHg,拆线后眼压为10.00～17.30(平均11.96)mmHg,两者间差异有统计学意义(P<0.05),28眼均无拆线并发症出现和滤过泡渗漏;术后28眼中Ⅰ度浅前房1例,Ⅱ度浅前房1例,浅前房发生率7%;28眼末次随访眼压10.00～17.30(平均12.55)mmHg;28眼最终形成扁平滤过泡20例,微小囊样滤过泡8例,功能滤过泡100%。结论:改良式巩膜瓣可拆除缝线法在急性闭角型青光眼小梁切除术中安全、有效,有利于远期眼压的控制和功能滤过泡的形成。

AIM： To evaluate the clinical effect of an improved suture method of scleral flap in trabeculectomy of acute angle-closure glaucoma. METHODS： Twenty-eight eyes（16 cases） with acute angle-closure glaucoma underwent trabeculectomy and peripheral iridectomy. An improved suture method of scleral flap was adopted during operation. RESULTS： All cases were followed-up for 6-12 months, averaging 8.7 months. The suture was pulled out during 3-17 days after operation, average 8.33 days. The intraocular tension was 12.23-18.86mmHg average 15.25mmHg before the suture being pulled out, and was 10. 00- 17.30mmHg , average 11.96mmHg（P〈0.05） after that. There were no complications and effusion of filter-bubble in all cases. The rate of shallow anterior chamber was 7% in 28 eyes（ Ⅰ grade ：1 case ; Ⅱ grade ：1 case）. At last, the intraocular tension in 28 eyes is from 10.00-17.30mmHg, averaging 12. 55mmHg. The eyes of applanation filterbubble, microcystic filter-bubble,and functional filter-bubble was 20,8, and 28 respectively. CONCLUSION： Improved suture method of scleral flap in trabeculectomy of acute angle-closure glaucoma is safe and valid , and in favor of intraocular tension controlling and functional filter-bubble forming in the long term.