两种不同形状小梁切除手术治疗原发性闭角型青光眼临床观察

The clinical observation of two different shapes trabeculectomy for treatment of glaucoma

目的：比较矩形长边垂直于角膜缘的竖向小粱切除手术（实验组）与矩形长边平行于角膜缘的横向小梁切除手术（对照组）治疗原发性闭角型青光眼的有效性与安全性。方法：选取2007年1月至2010年1月在我院进行治疗的单眼急性发作期的原发性闭角型青光眼患者94例为观察对象，其中实验组48例，对照组46。实验组采用矩形长边垂直于角膜缘的竖向小梁切除手术，对照组采用传统的矩形长边平行于角膜缘的横向小梁切除手术。分别观察3月、6月，12月两组患者眼压控制成功率、有效滤过泡形成率、术后并发症发生率等。结果：观察3月、6月、12月后两组患者眼压控制成功率有显著差异。术后并发症发生率及有效滤过泡形成率无显著差异。结论：矩形长边垂直于角膜缘的竖向小梁切除手术治疗原发性急性闭角型青光眼在术后眼压控制成功率方面优于传统矩形长边平行于角膜缘的横向小梁切除术，在有效滤过泡形成率、术后并发症的发生率等方面无明显差异。矩形长边垂直于角膜缘的竖l向小梁切除手术在保持经典小粱切除手术外滤过引流作用的同时，可能有增加房水通过schlemm管断端及脉络膜上腔引流的作用。

AIM： Compared to the efficacy and safety of different trabeculctomies for treatment of primary acute angle-closure glaucoma. The one type named test group was that we cut a piece of rectangular trabeculum vertical to corneoscleral limbus. The other one named control group was parallel to cor- neoscleral limbus. Methods：The 94 patients, whose one of eyes was with disease of primary acute angle-closure glaucoma, were collected from Jan 1,2007 to Jan 1,2010. All patiens were divided into the above two groups randomly. The test group contained 48 patients,and the control group contained 46 patients. We observed the achievement ratio of lowering intraoccular tension,the formation ratio of effective filtering bleb, and the incident ratio of postoperation corn plication at postoperation 3 month, 6 month and 12 month. Results：There was statistically significant difference between groups in the mean intraocular pres- sure at 6 and 12 months. And there was no statistically significant difference in the incident ratio of postoperation complications and the formation ratio of ef- fective filtering bleb. Conclusion： The trabeculectomy of long side of rectangular trabeculum vertical corneoscleral limbus was better than the long side of rec- tangular trabeculum parallel limbus in the postoperation intraocular pressure,for the treatment of primary acute angle-closure glaucoma. The trabeculectomy of long side of rectangular trabeculum vertical corneocleral limbus may not only contain the classic subconjunctiva drainage but also increases suprachoroidal and schlemm canal drainage.