两种结膜瓣在复合式小梁切除术后对形成功能性滤过泡的影响

Effect of two kinds of conjunctiva flap on the formation of filtration bleb after combined trabeculectomy.

目的比较穹隆部为基底的球结膜瓣和角膜缘为基底的球结膜瓣在青光眼复合式小梁切除术后对形成功能性滤过泡的影响。方法将45例(55眼)原发性青光眼并接受复合小梁切除术者随机分成2组:A组:27眼以角膜缘为基底的球结膜瓣;B组:28眼以穹隆部为基底的球结膜瓣。术后观察2组患眼眼压、滤泡、前房深度。全部患者术后观察6个月。结果 2种结膜瓣的复合式小梁切除术均有显著降眼压效果(P<0.01);功能性滤过泡的形成率差异也无统计学意义(P>0.05);术后早期眼球按摩促进滤泡形成中出现被动性滤泡渗漏B组多于A组。结论 2种结膜瓣的复合小梁切除术治疗青光眼都有相同良好的效果。鉴于穹隆部为基底的球结膜瓣在眼球按摩中有较高被动性滤泡渗漏,因此角膜缘为基底球结膜瓣的复合小梁切除术更安全。

Objective To compare the relative safety and effective of fornix-bascd eonjunctival flap and limbus-based conjunctival flap to the functional filtering bleb in glaucoma filtration surgery. Methods Choose 45 cases （55 eyes） of priamry glaucoma patients who receive combined trabeculectomy were randomlydivided into 2 groups ： A group （27 eyes） ： conjunctival flaps was limbus based; B group （28eyes）： conjunctival flaps was fornix based Theintraocular pressure, bleb appearance andanterior chamber depth were observedpostoperatively. All patients were followed up tothe 6 month postoperation. Results Filtration surgery was equally successful in both groups independent of the type of conjunctival flap （ P 〈 0.01 ）, and there was no statistical difference in the success rate of functional filtering blebs in the two groups （ P 〉 0.05 ） Group B developed bleb leak caused by eyeball massage were more than group A in the early postoperative period. Conclusions Filtration surgery is equally successful in both groups independent of the type of conjunctival flap. Fornix-based conjunctival flap is easier to develop bleb leak caused by eyeball massage than limbus-based conjuntival flap, which proves that limbus-hased conjuntival flap is more secure than fornix-based conjuntivai flap in combined trabeculectomy.