非穿透性小梁切除术治疗人工晶状体眼青光眼

Non-penetrating trabeculectomy in the treatment of pseudophakic glaucoma

目的:探讨非穿透小梁切除联合水凝胶植入术治疗人工晶状体眼青光眼的临床意义。方法:13例13眼人工晶状体眼青光眼患者均选取鼻上方位置,做以穹隆部为基底的结膜瓣后,做以角巩缘为基底4mm×5mm的浅层巩膜瓣,放置浸有0.2mg/mL浓度的丝裂霉素棉片3min后,取出棉片,用20mL生理盐水彻底冲洗干净。瓣下做一3mm×4mm深层巩膜瓣并切除,撕去Schlemm管内壁及邻近组织,可见房水渗漏明显增多,植入SKⅡ凝胶,间断缝合浅层巩膜瓣后连续缝合球结膜切口。结果:全部病例术中无1例出现前房出血或前房消失,有1例出现微穿。13眼术后眼压控制在8～16mmHg之间。2眼术后2mo后出现高眼压,经药物治疗或激光治疗后眼压控制正常。结论:非穿透小梁切除术是治疗人工晶状体眼青光眼的安全有效的术式之一。

AIM： To evaluate the effect of non-penetrating trabeculectomy in the treatment of pseudophakic glaucoma. METHODS： Thirteen glaucomatous patients （13 eyes） with intraocular lens were performed non-penetrating trabe-cular surgery. Supra nasal conjunctival flap with fornix sclerocorneal basement were made, then 4mm × 5mm superficial layer scleral flap was manufactured. Cotton hair full of 0.2mg/mL mitomycin C was put under the scleral flap for 3 minutes,and it was cleaned by 20mL physiological saline. A 3mm× 4mm deep lamella scleral flap under valve was formed and excised. Schlemm＇s canal intine and vicinity constitution were evulsioed. Aqueous humor infiltrated out slowly. SK Ⅱ gelatum was embed into the sclerotic socket. The superficial layer scleral flap and the conjunctiva were sutured. RESULTS： There were no hyphema and anterior chamber obliteration in all cases. Only one case occured micrpenetrate. Intra-ocular tensions in 13 eyes were between 8mmHg and 16mmHg. Two months later, intraocular hypertension happened in 2 eyes, but the ocular tension degraded after drug treatment or laser therapy. CONCLUSION： Non-penetrating trabeculectomy was one of the effective methods to treat glaucoma with intraocular lens.