小梁切除术中一种改良可拆缝线的疗效观察

A modified removable suture in trabeculectomy

目的 寻找一种既可避免术后早期房水过量流出,又能恰当地控制滤过量的安全、简便和有效的手术方法。方法 选择急慢性闭角型青光眼99例,126眼做标准的小梁切除术,巩膜瓣后缘全3针固定缝线,两侧近角膜缘处各作1针固定缝线,两侧中部各缝1活动缝线。结果 126眼中术后1周内46眼眼压≥15mmHg(1mmHg=0.133kPa)需拆除活动缝线,其中26眼眼压从拆线前22.4±6.5mmHg降至11.6±2.6mmHg,10眼术后1d Ⅰ°浅前房,其中5眼术后4d恢复,2眼术后7d恢复正常,3眼术后6d出现Ⅱ°浅前房,术后分别12、14、18d恢复,总发病率为10.3％。结论 改良活结缝线方法操作简单,不影响滤过泡,不留缝线残端在结膜囊或角膜面上,无刺激症状及不适感觉,是一种小梁切除术中预防早期浅前房的有效方法。

Aim To develop a safe, simple and effective surgical procedure, which can not only prevent the excessive outflow of aqueous humor, but also matintain an appropriate filtration rate. Methods One hundred and twenty six eyes of 99 patients with primary a-cute or chronic primary close-angle glaucoma were treated with standard trabeculectomy. There were three permanent sutures on the posterior edge of the scleral flap, one permanent suture on each side near the limbus, and one removable suture in the centre of each side. Results Degree 1 shallow anterior chamber (AC) occurred in 13 eyes on the first postoperative day, which resolved spontaneously within 4 days in 8 eyes and within 7 days in 2 eyes. Degree 11 shallow AC occurred in 3 eyes on the sixth postoperative day, which resolved after conservative management by the 12th, 14th and 18th postoperative day respectively. The total incidene of shallow AC was 10.3% within the first postoperative week. The removable suture were pulled out in 46 eyes due to a value of intraoular pressure (IOP) ±15mmHg, and in 26 eyes IOP dropped from 22.4±6.5mmHg to 11.6±2.8mmHg immediately after suture removal. Conclusion The procedure is easy to carry out and does not affect the filtration bleb. There are no suture ends left on the surface of the cornea or in the conjunctive sac. Nor are there irritation symptoms, or uncomfortable sensations. So it is an effective surgical procedure to prevent shallow AC in the early postoperative period of trabeculectomy.