青光眼小梁切除术巩膜瓣松解缝线的临床观察

Clinical observation on suture lysis for scleral flap in trabeculectomy

目的 :研究和评价青光眼小梁切除术联合巩膜瓣松解缝线手术的临床效果。方法 :根据随机分配原则将各类青光眼分成治疗和对照两组 ,各 50例 ,两组在性别、平均年龄、青光眼分类和术前平均眼压方面差异无显著性 (P >0 0 5)。并将两组术后前房形成情况及深度的变化、术前及最后随访的眼压、术后滤过泡情况及手术并发症进行比较。结果 :治疗组术后第 1天无浅前房发生 ,第 3、4天出现浅 /无、Ⅱa、Ⅱb各 1例。对照组术后第 1天发生浅Ⅰ级 9例 ,术后 3～ 7天发生浅Ⅱ级 7例、浅Ⅲ级 5例。两组经统计学处理有显著性差异 (P <0 0 0 5)。治疗组术前眼压平均为 4 82± 1 53kPa ,最后随访眼压平均为 1 94± 0 2 3kPa。眼压在 2 74kPa以下者 4 3只眼 ,占 86%。对照组术前眼压平均为 4 57± 1 64kPa,最后随访眼压平均为 2 3 1± 0 4 4kPa。眼压在 2 74kPa以下者 3 6只眼 ,占 72 %。治疗组术后功能性滤过泡占90 % ,对照组占 66% ,经统计学处理有显著性差异 (P <0 0 1 )。治疗组术后无晶体混浊加重发生 ,对照组发生 7例 ( 1 4 % )。结论 :青光眼小梁切除术联合巩膜瓣松解缝线手术 ,不仅能主动调整滤过功能 ,很好的控制眼压 ,而且能减少并发症的发生 ,从而大大提高抗青光眼的手术疗效。

Objective:To study and evaluate the outcome of suture lysis for scleral flap in trabeculectomy.Methods:100 patients (100 eyes)with glaucoma were randomly divided into study group(50eyes)and control group(50eyes).There were no significant statistical differences between two groups with respect to sex,average ages,classification of glaucoma and mean preoperative IOP(P>0 05).After trabeculectomy,formation of anterior chamber,pre and postoperative IOP,filtration blebs and complications were compared.in the two groups.Results:On the first postoperative day,no shallow anterior chamber developed in the study group,but there were 9 eyes with shallow anterior chamber in the control group.Statistically,significant difference between two groups.Of the study group,the IOP values in 43 eyes were below 2 74kPa(86%) the mean postoperative IOP was 1 94kPa±0 23kPa.Of the control group,the IOP values in 36 eyes were below 2 74kPa(72%) and the mean postoperative IOP was 2 31kPa±0 44kPa.In the study group,no one developed increased lens opacity while there were 7 eyes (14%)in the control group,the lens opacities increased.Conclusion:Trabeculectomy combined with suture lysis for scleral flap not only can regulate the function of filtration and control the IOP,but also decrease the occurrence of complications increasing the efficacy of anti glaucoma surgery greatly.