复合式小梁切除术中采用角巩膜缘后界1mm结膜切口的疗效观察

Efficacy observation on combined trabeculectomy with conjunctival incision at 1mm of corneoscleral limbus posterior

目的:观察改良的角巩膜缘后界1mm结膜切口在复合式小梁切除术的临床疗效。方法:回顾性分析原发性青光眼171例220眼,根据结膜瓣切口不同及缝合方法不同,分为三组,A组采用传统的角巩缘切口33例44眼,B组采用角巩缘后界1mm结膜切口76例94眼,C组采用B组结膜切口基础上连续缝合结膜瓣62例82眼,随访1a。观察术后眼压、滤过泡、前房深度、结膜切口有无渗漏,并进行组间比较三组的临床效果。结果:术后切口漏水、浅前房发生A组>B组>C组,具有统计学意义(P<0.05),手术成功率94.5%,术后眼压控制和滤过泡形态无明显区别。结论:角巩膜缘后界1mm结膜切口制作结膜瓣,同时采用结膜切口连续缝合,愈合快,发生结膜切口漏水明显减少,显著能提高复合式小梁切除术的成功率。

AIM： To observe the therapeutic effect of combined trabeculectomy with improved conjunctival incision at 1 mm of corneoscleral limbus posteriorMETHODS： A retrospective analysis of 171 cases（220eyes） with primary glaucoma who were randomly divided into 3 groups according to the differences of conjunctiva incision and the way of suture. Group A： 44 eyes of 33 cases underwent corneoscleral limbus conjunctiva incision; Group B： 94 eyes of 76 cases underwent conjunctival incision at 1mm of corneoscleral limbus posterior; Group C： 82 eyes of 62 cases underwent conjunctival flap running suture based on group B. Al cases were followed up for 1a. Intraocular pressure,m orphology of filtering bleb, depth of anterior cham ber and w ater leakage in conjunctival incision w ere observed and com pared after operation am ong three groups.RESULTS： The incidence of postoperative water leakage inconjunctival incision and shallow anterior chamber were group A group B group C and there were significant differences among the three groups（ P〈0. 05）, The success rate was 94. 5%. The intraocular pressure and morphology of bleb had no significant differences among the three groups. CONCLUSION： Conjunctival incision at 1mm of corneoscleral limbus posterior and conjunctival flap running suture can not only reduce the rate of water leakage in conjunctival incision and accelerate the speed of incision adhesion after operation,but also significantly enhance the therapeutic effect of combined trabeculectomy.