小梁造瘘联合深层巩膜切除术的疗效观察

The clinical observation on trabeculostomy with deep sclerectomy

目的 :评价小梁造瘘联合深层巩膜切除术治疗闭角型青光眼的疗效。方法 :对 16例 (16只眼 )闭角型青光眼患者实施了小梁造瘘联合深层巩膜切除术 ,术后观察视力、前房、房角、眼压及滤过泡变化。随访时间 6～ 15个月 ,平均 11 5个月。结果 :11只眼视力增加 2～ 4行 ,5只眼无变化。术后第 1天 12只眼前房形成 ,房角镜检查见巩膜条之间的房角开放 ,16只眼术后 7个月眼压均低于 15 75mmHg(1mmHg =0 133kPa) ,其中 2只眼术后 8个月眼压达 19 2 5mmHg ,16只眼结膜滤过泡弥散。 4只眼术后浅前房 ,其中 1例经B超证实为脉络膜脱离 ,给予局部滴类固醇眼药水、口服醋氮酰胺和加压包扎等处理后前房加深 ,脉络膜脱离复位。结论 :小梁造瘘联合深层巩膜切除术是一种安全可靠有效的抗青光眼手术。

Objective:To evaluate the curative effect of trabeculostomy with deep sclerectomy (TDS)on primary close-angle glaucoma (PCAG).Methods:TDS was performed on 16 eyes of 16 patients.The procedure included laminating a half-thickness quadrangular or a triangular scleral flap,making two scleral strips in which Schlemm's canal was included and introducing strips into the anterior chamber angle.The visual acuity,anterior chamber depth,scleral strips inserted into the angle,intraocular pressure (IOP) and bleb were observed postoperatively.The mean follow-up was 11.5 months.Results:11 eyes obtained higher visual acuity,and 5 eyes were maintained visual acuity at their pre-operative level.The strips inserted into the angle of anterior chamber were kept the angle patent.The IOP of 16 eyes had been maintained at less than 15.75 mmHg.7 months after operation,among which 2 eyes reached to 19.25 mmHg 8 months after operation and then remained the same.The functioning filtering blebs were formed in all eyes,flat chamber in 4 eyes and choroidal detachment in one eye which became normal by treating with steroid eyedrop,Diamox and firmly taped eye pad.Conclusion:Trabeculostomy with deep sclerectomy is a safe,reliable and effective surgical therapy for primary close-angle glaucoma.