不同巩膜瓣缝合法在急性闭角型青光眼小梁切除术中的观察

Clinical observation of different sewing method of scleral flap in trabeculectomy of acute angle-closure glaucoma

目的:比较改良巩膜瓣可拆除缝线法与传统缝合法在急性闭角型青光眼小梁切除术中的临床效果。方法:42例68眼接受小梁切除术的急性闭角型青光眼患者中,A组16例28眼术中采取改良巩膜瓣可拆除缝线法;B组26例40眼术中施行传统巩膜瓣缝合法。结果:所有患者随访6～12(平均6.7)mo。A组术后拆巩膜缝线时间3～17(平均8.33)d。A、B组术后早期浅前房分别有2眼(7%)和12眼(30%),差异有统计学意义(P<0.05),术后2wkA、B组眼压分别为10～19(平均13.31)mmHg和6～42(平均14.64)mmHg,两组差异无统计学意义;术后6moA、B组眼压分别为10～17.30(平均11.96)mmHg和7～44(平均15.17)mmHg,两组差异无统计学意义;A、B组最终形成功能滤过泡28眼(100%)和36眼(90%),两组差异无统计学意义。结论: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应用是安全有效的,它较传统方法更能降低术后早期浅前房的发生。

AIM： To compare the clinical effect of improved sewing method and traditional sewing method of scleral flap in trabeculectomy for acute angle-closure glaucoma. METHODS： Forty-two eyes 68 cases with acute angle- closure glaucoma underwent trabeculectomy and peripheral iridectomy, A group 16 cases 28 eyes： improved sewing method of scleral flap was adopted during operation; B group 26 cases 40 eyes： traditional sewing method of scleral flap was used during operation. RESULTS：All cases were followed-up for 6-12 months, averaged 6.7 months. A group- the suture was pulled out 3-17 days after operation, averaged 8. 33 days. The shallow anterior chamber was 2 cases （7%） in A group and 12 cases（30%） in B group, there was significant difference between 2 groups （ P 〈 0.05）. The intraocular tension was 10-19mmHg （ averaged 13.31 mmHg） in A and 6-42mmHg （averaged 14.64mmHg） in B after 2 weeks, there was no significant difference between 2 groups. The intrao- cular tension was 10-17.30mmHg （averaged 11.96mmHg） in A and 7-44mmHg（ averaged 15.17mmHg） in B after 6 months, there was no significant difference between 2 groups. The functional filterbubble was 28 cases（100%） in A and 36 cases （90%） in B, there was no significant difference between 2 groups. CONCLUSION ： It is safe and effetive that the improved sewing method of scleral flap for trabeculectomy of acute angle-closure glaucoma, and it is a better method to avoid the occurrance of shallow anterior chamber than the traditional sewing method in the forepart after operation.