青光眼小梁切除手术并发症及预防

Prevention of Surgical Complications of Trabeculotomy

目的探讨青光眼小梁切除引起并发症的相关因素及其预防措施。方法回顾性分析我院１９９４年９月～１９９４年１２月住院行眼小梁切除术的连续病人５０例共６４只眼，其中３２只眼进行了较长期随访，观察眼压、视力、晶状体和滤枕形态，平均随访期为３５．５７月结果近期手术成功率９３．７５％。随着随访时间延长，不加药物控制眼压的有效率降低至４６．８７％，加用眼药后有效率为９６．８８％。术后前房延缓形成的发生率为４０．６２％，大多因滤过过畅及脉络膜脱离引起。前房积血的发生率为７．８１％。结论１．前房延缓形成与结膜瓣切口类型无关，与术前眼压控制程度有关。２．术后眼压能否长期控制与术前用抗青光眼药物及眼压控制状况有关。３．服压的控制与滤枕的形态有关。

Obiective To analyze the causes of complications in trabeculotomy and to elucidate their prevention. Methods Surgical complications of 64 eyes in 50 patients selected randomly were studied. The lOP, vision, clarity of lens, and type of filtering bled were followed up in 32 eyes(32/64) from 27 to 55 months with an average of 35.6 months postoperatively. ResultS A flat shallow anterior chamber was found in 40.62% of the operated eyes (26/64) and hyphyma in 7.8%. 93.75% of operated eyes (60/64) had IsOP under control 1 month postoperation. 46.7% of the followed up eyes (15/32) was found to have IOP under control 27-58 months post-operation. With an aid of medication, the IOP of 50% of the followed up eyes (16/32) with a total effective rate (96.88%) was well controlled. Co'clusion 1. A preoperative lOP out of control may be responsible for the flat shallow anterior chamber, but not with the type of surgical incision. 2. A better long term result of trabeculotomy depends on preoperative medication and well control of the lOP. 3. An effective fittering bled plays an important role in the postoperative control of the lOP.