表面麻醉下的青光眼小梁切除并虹膜周切术

SURFACEANESTHESIA FOR TRABECULECTOMY AND IRIDECTOMY IN PATIENS WITH GLAUCOMA

目的 评估采用表面麻醉对原发性闭角型青光眼的小梁切除并虹膜周切术的可靠性、有效性及安全性。方法对 5 7例原发性闭角型青光眼患者经表面麻醉进行青光眼小梁切除并虹膜周切术 ,随机选取同期手术的另外 5 7例患者采用标准的球后麻醉作为对照组。比较两组患者不同麻醉方法的并发症 ,以及两组患者术中配合程度及疼痛感。结果 表面麻醉组中仅有 4例发生球结膜下出血。球后麻醉组中 ,结膜下出血、眼睑出血及球后出血等并发症的发生率显著高于表面麻醉组 (P <0 .0 1 )。表面麻醉组中仅 5例虹膜周切时感轻度疼痛感 ,其余 5 2例患者均无明显疼痛感 ,与球后组比较差异无显著性意义 (P >0 .0 5 )。结论 表面麻醉对于青光眼小梁切除并虹膜周切术是一种安全、有效、并发症少的麻醉方法。

Objective To evaluate and compare the efficacy, liability and safety of surfaceanesthesia and retrobulbar anesthesia for Trabeeuleetomy and iridectomy.Methods 57 glaucoma patients were assigned to the surfaceanesthesia group and 57 patients to the retrobulbar anesthesia group. Trabeculectomy and iridectomy were performed in all patients in both surfaceanesthesia and retrobulbar anesthesia groups. The complications, patients' cooperation and pain during surgery in both groups were compared.Results Four patients had subconjunctival hemorrhage in the surfaceanesthesia group ,The incidences of subconjunctival hemorrhage? eyelid hemorrhage and retrobulbar hemorrhage were significantly higher in the retrobulbar anesthesia group compared with those in the surfaceanesthesia group (P<0.01). Only 5 patients in the surfaceanesthesia group experienced minor and tolerable pain during iridectomy. 52 patients in the surfaceanesthesia group cooperated well with the surgeons during surgery. It's difference is insignificant to compare with retrobulbar anesthesia group(P>0.05).Conclusion surfaceanesthesia can be used safely and effectively for trabeculectomy and iridectomy with less fewer complications. However, pre-operalive screening and training are the keys to the safe use of surfaceanesthesia