青光眼小梁切除术后再次手术的临床观察

Clinical observation of reoperation after trabeculectomy

目的评价青光眼小梁切除术后眼压再次升高者行复合式小梁切除术的疗效观察。方法对22例（25眼）曾行小梁切除术后眼压再次升高者行小梁切除联合羊膜移植和巩膜瓣可调节缝线术。术后1d、1周、1个月、3个月、6个月、12个月随访，观察视力、眼压、前房深度、滤过泡以及并发症。结果术后1d眼压（8．08±1．85）mmHg（1mmHg=0．133kPa），眼压显著低于术前的（31．92±6．74）mmHg，有3眼出现低眼压、浅前房，经治疗后恢复。术后1周、1个月、3个月、6个月、12个月平均眼压分别为（11．68±3．47）、（17．88±3．41）、（19．12±2．62）、（20．32±3．16）、（19．16±1．31）mmHg，与术前平均眼压的差异有统计学意义（P〈0．001）。至随访结束，10眼视力提高，另15眼视力维持不变。随访期间所有病例均未出现滤过泡渗漏、结膜漏水或其他严重并发症。结论再次手术施行复合式小梁切除术，能有效降低眼压，保留功能型滤过泡，且并发症少，治疗复发性青光眼患者是安全有效的。

Objective To evaluate the clinical efficacy of reoperation in patients who had underg- one previously failed trabeculectomy surgery. Methods Twenty five eyes of twenty two patients underwent trabeculectomy augmented with amniotic membrane transplantation and scleral adjustable suture following a previously failed trabeculectomy. The visual acuities, intraocular pressure （IOP） , anterior chamber depth, fihering bleb and complications were recorded at 1 day, 1 week, and 1,3,6 and 12 months after surgery. Re- sults At day 1 ,the average IOP was （ 8.08 ± 1.85 ） mmHg（ 1 mmHg =0. 133 kPa） ,which was significant lower than the preoperative level. There were 3 eyes complicated with ocular hypotension and shallow anterior chamber, which recovered after treatment. The average IOP was （ 11.68 ± 3.47 ）, （ 17.88 ± 3.41 ）, （ 19.12 ± 2.62）, （20.32 ±3.16）, （ 19.16 ± 1.31 ） mmHg at 1 week, 1,3,6 and 12 months after surgery, which was significant different from the preoperative level （P 〈 0.001 ）. The visual acuities were improved in 10 eyes and no change in 15 eyes at the end of follow-up. No filtering bleb leakage or other complication was noted. Conclusion Repeat trabeculectomy following a previously failed trabeculectomy is safe and effective which can control lOP with few complications.