取得更低眼压的青光眼复合小梁切除手术方法

A complex trabeculectomy to achieve lower intraocular pressure for glaucoma

目的探索取得更低眼压水平的安全的青光眼复合小梁切除手术方法。方法观察接受复合小梁切除手术的65岁以下的原发慢性闭角型青光眼和原发开角型青光眼病人81例（98只眼），随机分为两组，即改良组和标准组。改良组25例患者（31只眼），巩膜瓣为5mm×3mm×5mm长方形，约1／4～1／3厚，缝3针可调节缝线；标准组56例患者（67只眼），巩膜瓣5mm×4mm×4ram梯形，约1／2—1／3厚，缝2针可调节缝线，分析两组手术后浅前房发生率和3月时眼压情况。结果浅前房情况：改良组31只眼，5例5只眼发生浅前房，其发生率为16．1％；标准组67只眼，5例5只眼发生浅前房，其发生率为7．5％。经x。检验分析，两组浅前房发生率的差别无统计学显著性意义（χ2=1．74，P〉0．1）。手术后3个月眼压：改良组为8．1～16．5mmHg，平均为（12．5±1．9）mmHg，而标准组为8．9—24．8mmHg，平均为（16．4±3．6）mmHg，经t检验，两组均值的差异有统计学意义（t=2．36，P〈0．05）。结论与普遍采用的标准复合小梁切除手术相比，改良的复合小良切除手术后获得更低的眼压水平，同时浅前房发生率低。

Objective To explore save complex trabeculectomy to achieve lower intraocular pressure in glaucoma. Methods Eighty-one patients （98 eyes） with primary chronic glaucoma received complex trabeculectomy in our hospital and were reviewed. All of the patients were divided into two groups according to the number of adjustable sutures of the operated eyes. The two groups were the modified and the standard. There were 25 cases （31 eyes） in modified group. All of the eyes had received complex trabeculectomy with 3 adjustable sutures and a scleral flap of 5× 3× 5mm and 1/4- 1/3 sclera thick. There were 56 cases （67 eyes） in standard group. All of the eyes had received complex trabeculectomy with 2 adjustable sutures and a scleral flap of 5× 4×4 mm and 1/2 -1/3 sclera thick. The incidence rates of shallow anterior chamber and the intraocular pressures 3 months after operation were analyzed retrospectively. Results Shallow anterior chamber： There were 5 cases （5 eyes） occurrence in modified group （31eyes） with incidence rate of 16.1%. Among them 3 were the grade 1 and 2 were grade II. There were 5 cases （5 eyes） occurrence in standard group （67 eyes） with incidence rate of 7.5%. Among them 2 were the grade I, 2 were grade II and 1 was grade III. Analyzed by chi square test, the difference of. the incidence rates of the two groups was no significant of statistically （X 2=-1.74, P〉0.1）. Intraocular pressures 3 months post-operation： The range of the pressure was 8.1 to 16.5 mmHg with the average of 12.5± 1.9 mmHg in modified group. The other range of the pressure was 8.9 to 24.8 rnmHg with the average of 16.4± 3.6 mmHg in standard group. Analyzed by t test, the difference of the averages of the two groups was statistically significant （t=2.36, P 〈0.05）. Conclusions Compared with the standard complex trabeculectomy which is common used by eye doctors at present, the modified complex trabeculectomy is more effective for glaucoma to get the intraocular pressure at lower level after operation and the incidence of shallow anterior chamber is low.