小梁切除术联合硅胶片植入治疗难治性青光眼

Trabeculetomy Combined with Implantation of Silicon Rubber Slice for Intractable Glaucoma

目的:观察小梁切除术联合巩膜层间硅胶片填充治疗难治性青光眼的效果及并发症。方法:60眼难治性青光眼（包括新生血管性青光眼12眼,无晶体或人工晶体性青光眼14眼,先天性青光眼4眼,滤过性手术失败的青光眼18眼,外伤性青光眼12眼）作小梁切除术联合硅胶片填充于巩膜层间,术后观察其降眼压效果及并发症。结果:术后随访5～34个月（平均18.3个月）,最后一次随访时的眼压范围是17.30～37.19mmHg[平均（23.36±4.06）。Hg],其中38眼（63.3％）术后眼压降至21 mmHg以下,18眼（30％）眼压在21～30 mmHg之间,仅4眼（6.7％）术后眼压高于30 mmHg,术后随访时间内未发现与硅胶片填充有关的严重并发症及硅胶片排斤反应。结论:小梁切除术联合巩膜层间硅胶片植入是治疗难治性青光眼的有效方法,尤其是在我国广大基层医院可以代替昂贵进曰引流性植入物治疗难治性青光眼,因此,值得推广应用。

Purpose: To investigate the lowering-pressure outcome and postoperative complications of trabeculectomy with implantation of silicon rubber slice for intractable glaucoma. Methods: Sixty eyes with intractable glaucoma, including 12 eyes with neovascular glaucoma, 14 eyes with aphakic or pseudophkic glaucoma, 4 eyes with congenital glaucoma, 18 eyes with failed filtering surgery glaucoma and 12 eyes with glaucoma secondary to trauma, were performed trabeculectomy with implantation of silicon rubber slice. The postoperative lowering-pressure outcome and complications also were observed. Results: All patients were follow-up for 5-34 months ( mean, 18. 3 months) . The postoperative intraocular pressure of patients was 17.30-37.19 mmHg [mean, (23.36±4.06) mmHg] at the last visit. Of 60 eyes, the postoperative intraocular pressure was below 21mmHg in 38 eyes(63. 3% ), between 21 to 30 mmHg in 18 eyes (30% ) and higher than 30 mmHg only in 4 eyes (6. 7% ). No serious complications and rejection related to implatation of silicon rubber slice occurred in this group during the follow-up period.Conclusion: Trabeculectomy combined with implantation of silicon rubber slice seems to be an ideal procedure for treatment of intractable glaucoma in developing countries, especially in vast country hospital in China, this surgery also can replace the expensive import drainage device implant(Molteno tube implant) therapy for intractable glaucoma.