改良显微小梁切除术治疗葡萄膜炎继发性青光眼

目的 探讨小梁切除术中采用虹膜节段切除联合应用丝裂霉素C(MMC)及粘弹剂治疗葡萄膜炎继发性青光眼的临床疗效.方法 术中根据患者的年龄、炎症和结膜Tenon囊情况选用不同浓度的MMC(0.25～0.33 mg/ml),应用粘弹剂分离虹膜前后粘连和瞳孔区机化膜并剪除机化膜,节段切除虹膜,可控缝线缝合巩膜瓣.观察手术前后视力、眼压、炎症和术后并发症情况.结果 葡萄膜炎继发性青光眼共38例42眼,平均随访时间(12.01±3.56)月.术后末次复查与术前比较,视力提高14眼,不变28眼;前房炎症消失35眼,减轻7眼;平均眼压(15.20±4.64)mmHg与术前(38.37±12.93)mmHg比较差异有统计学意义(t=8.255,P=0.000).手术总成功率92.9%,无严重并发症发生.结论 小梁切除术术中联合应用MMC、粘弹剂、虹膜前后粘连分离、虹膜节段切除及可控缝线技术能够提高较严重葡萄膜炎继发性青光眼的手术成功率,减少手术并发症及术后炎症反应,减少葡萄膜炎复发.     

Schlemm管引流联合复合式小梁切除术治疗外伤性青光眼

目的探讨Schlemm管引流联合复合式小梁切除术治疗外伤性青光眼的可行性和疗效评价。方法对23例(23眼)因眼外伤房角后退继发开角型青光眼患者施行Schlemm管引流联合复合式小梁切除术,术后观察眼压、矫正视力、前房情况、术后并发症和滤过泡的形态等。术后随访6～24个月,平均(14.46±9.16)月。结果术后1 d、1周、1月、3月、6月、12月平均眼压分别为(8.7±3.19)mmHg、(9.14±4.62)mmHg、(13.62±3.10)mmHg、(13.77±4.11)mmHg、(14.55±6.02)mmHg、(15.98±5.12)mmHg。与术前平均眼压(31.73±8.66)mmHg比较差异均具有统计学意义(P均<0.05)。最末次随访平均眼压(16.41±4.25)mmHg,与术前平均眼压比较,差异具有统计学意义(t=13.547,P=0.000)。术后21眼眼压控制在正常范围,手术成功率91.30%。15眼(65.22%)形成功能性滤过泡,6只眼(26.09%)为非功能滤过泡,但眼压正常范围内。术后并发症主要是早期前房出血。结论Schlemm管引流联合复合式小梁切除术治疗外伤性青光眼安全有效,并发症少,具有良好临床应用前景。     

超声乳化治疗青光眼合并白内障临床观察

目的:观察超声乳化白内障摘除人工晶状体植入联合虹膜周边切除术或小梁切除术治疗青光眼合并白内障的疗效。方法:采用单纯表麻下超声乳化白内障摘除人工晶状体植入治疗白内障继发青光眼不伴房角损害9眼(术式Ⅰ);表麻下超声乳化白内障摘除人工晶状体植入加周边虹膜切除术治疗病人14眼(术式Ⅱ);球周麻醉超声乳化白内障摘除人工晶状体植入加小梁切除术治疗病人13眼(术式Ⅲ);术后随访3个月～2年。结果:术前平均视力0.06,术后平均视力0.5;术前平均眼压(27.63±2.31)mmHg,(1mmHg=0.133KPa),术后平均眼压(15.62±1.76)mmHg。结论:上述三种术式治疗青光眼合并白内障,具有恢复有用视力,控制眼压满意的理想效果。     

青光眼白内障联合手术中改良小梁切除与经典小梁切除对比研究

目的探讨改良小梁切除术与经典小梁切除术治疗原发性闭角型青光眼合并白内障的疗效。方法随机将150例原发性闭角型青光眼合并白内障患者分为常规组和改良组,每组75例。常规组采用经典小梁切除术联合超声乳化人体晶体植入术,改良组采用改良小梁切除术(带三角形深巩膜床切除)联合超声乳化人体晶体植入术,观察临床疗效。结果治疗后,改良组患者视力中0.1、0.1~0.3和0.5与同组治疗前相比差异有统计学意义(χ2=12.0382,P0.01;χ2=4.6251,P0.05;χ2=13.0434,P0.01)。常规组视力中0.1、0.1~0.3和0.5与同组治疗前相比差异有统计学意义(χ2=4.2386,P0.05;χ2=4.2386,P0.05;χ2=7.3426,P0.01)。与术前相比,术后改良组与常规组的眼压差异均有统计学意义(t=35.4059,P0.01;t=30.0784,P0.01)。手术后,与常规组相比,改良组的眼压与治疗前后下降值差异均有统计学意义(t=10.5466,P0.01;t=24.981,P0.01)。结论改良小梁切除术在治疗闭角型青光眼中,能有效改善患者视力,降低患者的眼压,具有较好的效果,是安全可行的。     

非穿透小梁手术联合羊膜移植治疗继发开角型青光眼的护理

对16例(16眼)患者行非穿透小梁手术(NPTS)联合羊膜移植治疗,同时给予针对性护理.结果术后1、3、6、12和24个月平均眼压分别为(13.52士4.71)mmHg、(16.30±4.11)mmHg、(16.38±4.26)mmHg、(16.54±4.39)mmHg和(17.60±4.58)mmHg,与术前眼压[(46.24±9.32)mmHg]比较,差异有显著性意义(均P＜0.01).随访24个月,15例眼压15～21 mmHg;1例眼压升高,再行穿透小梁切除术后眼压降至20 mmHg以下,手术成功率为93.75%.提出术前指导、术后严密观察视力、眼压变化,眼部炎症反应及滤过泡情况,指导患者按时复诊是保证手术效果的护理要点.     

贝伐单抗在新生血管性青光眼中的应用

目的 观察贝伐单抗在新生血管性青光眼治疗中的作用. 方法 选择2008年3月至2010年6月入住本院的15例(15眼)NVG患者,玻璃体腔内注射贝伐单抗1.25 mg/0.05 ml,前房角及虹膜新生血管消失后接受小梁切除术(联用抗代谢药丝裂霉素C).随访观察患者视力、眼压、虹膜、前房角新生血管情况. 结果 所有患者平均随访12个月,注射后7d所有患者前房角及虹膜表面新生血管均消失,平均眼压为(27.53±5.25) mmHg,术后1d、1周、1个月、6个月、12个月时平均眼压分别为(14.93±4.11)、(16.40±3.48)、(17.33±3.15)、(19.27±4.54)、(19.60±3.68) mmHg,均明显低于注药前水平[( 37.80±6.25) mmHg,P＜ 0.01].随访结束时眼压完全控制10只眼,部分控制5只眼;视力无变化或较术前改善,虹膜新生血管无复发. 结论 术前使用贝伐单抗可以有效清除虹膜和前房角新生血管,减少术中、术后出血风险,有助于后期通过显微外科技术来治疗NVG.     

急性闭角型青光眼合并白内障行窦小梁切除术联合超声乳化白内障吸除术的疗效观察

目的:观察窦小巢切除术联合白内障超声乳化吸除术、人工晶体植入术(三联术),对治疗青光眼合并白内障患者的疗效.方法:对41人41眼急性闭角型青光眼合并白内障患者进行手术治疗,采用改良窦小梁切除术联合白内障超声乳化吸除术、人工晶体植入术.术后随访1-10个月.结果:术前眼压16～36mmHg,平均26mmHg,术后随访最终眼压12～21mmHg,平均眼压17mmHg,手术前后眼压变化有显著性差异.术后视力<0.1者5眼,此5例患者均有眼底视神经萎缩;0.1～0.5者11眼;>0.5者22眼.结论:改良宾小梁切除三联手术治疗青光眼合并白内障患者,具有恢复视力、稳定眼压、减少术后用药,并发症少等效果.     

双切口小梁切除联合超声乳化显微手术治疗青光眼合并白内障

目的　探讨双切口小梁切除联合超声乳化白内障显微手术治疗青光眼合并白内障的临床疗效。　方法　施行双切口小梁切除联合超声乳化白内障吸除术 46例 ( 4 8眼 ) ,术后随访 6～ 3 6个月 ,分析术后眼压、视力等情况。　结果　术前眼压 15 2 8～ 3 2 17mmHg ,术后随访最终眼压 7 10～ 2 0 5 5mmHg ,两者差异有显著性 (t=8 92 ,P <0 0 0 1) ;术前视力眼前光感～ 0 3 ,术后视力大于 0 2者 41眼 ,较术前明显好转 ,经配对 χ2 检验 ,差异有显著性 χ2 =14 0 3 ,P <0 0 0 1)。　结论　双切口小梁切除联合超声乳化白内障显微手术治疗青光眼合并白内障 ,能达到恢复有用视力及降低眼压等效果。     

急性闭角型青光眼采用GSL+Phaco+IOL治疗疗效观察

目的探讨急性闭角型青光眼采用房角分离+白内障超声乳化人工晶体植入术(GSL+Phaco+IOL)治疗疗效。方法选取2017年1月至2018年6月78例急性闭角型青光眼患者纳入此次研究,按照治疗方法不同将其分组为对照组与观察组,各39例;对照组行超声乳化白内障吸除植入人工晶体与小梁切除术治疗;观察组行GSL+Phaco+IOL治疗。分别于治疗前、术后3天、7天、1个月、6个月时眼压;评价两组术前、术后视力情况。记录两组患者术前、术后中央前房深度、周边前房深度、房角、晶状体厚度、眼轴长度及手术成功率、术后并发症。结果两组术后3天、7天、1个月、6个月时眼压较术前明显下降,而对照组下降程度较观察组明显,P0.05。两组患者术后视力较术前明显改善,P0.05;两组术后视力比较,P0.05。两组术后中央前房深度、术后周边前房深度、房角较术前明显增加,而观察组中央前房深度、房角增加程度较对照组显著,P0.05;而两组术后周边前房深度比较,P0.05。两组术后晶状体厚度较术前明显下降,P0.05,术后组间比较,P0.05;两组术后眼轴长度与术前及组间比较,P0.05。观察组术后并发症率为25.64%,明显低于对照组48.72%,χ~2=4.446,P=0.035。两组手术成功率相比较,P0.05。结论急性闭角型青光眼患者采用GSL+Phaco+IOL与超声乳化白内障吸除人工晶体植入联合小梁切除术治疗均可取得较好效果,后者在眼压控制方面具有较大优势,前者在中央前房深度加深及房角改善方面具有更多优势,且术后并发症更少。     

瞳孔成形术对老年急性闭角型青光眼患者视力恢复及眼压水平的影响

目的探讨瞳孔成形术对老年急性闭角型青光眼患者视力恢复及眼压水平的影响。方法随机将94例老年急性闭角型青光眼患者分为2组,各47例。在降眼压基础上,对照组采取小梁切除术+白内障摘除术+人工晶体植入术,观察组联合瞳孔成形术。随访1a,比较2组患者视力恢复情况、眼压水平、瞳孔直径及并发症发生率。结果观察组视力0. 1的患者比例低于对照组,视力 0. 3的患者比例高于对照组,眼压水平、瞳孔直径及并发症总发生率均低于对照组,差异均有统计学意义(P 0. 05)。结论瞳孔成形术治疗老年急性闭角型青光眼,可改善患者的视力,降低眼压水平及瞳孔直径,降低并发症发生率。     

Deep sclerectomy with trabeculotomy ab externo: one-stage procedure (DS 1)

Our new full-thickness filtering procedure was performed on 20 eyes with narrow-angle glaucomas (15 patients, mean age 69 +/- 12 years) with high intraocular pressure (IOP) despite initial peripheral iridectomy. This procedure was intended to maintain anterior chamber depth completely during intraoperative and postoperative periods. Under conjunctival and thin scleral flaps, the deep (4 X 1.5 mm) scleral block containing the outer wall of Schlemm's canal was removed. After closing the scleral flap with eight interrupted sutures and the conjunctival flap with a running suture, a 1-mm spatula was inserted beneath the scleral flap, and the trabeculum was punctured. The mean preoperative and final postoperative IOPs were 34.8 +/- 17.2 mm Hg and 14.9 +/- 4.9 mm Hg, respectively. Follow-up time was at least 12 months. Final postoperative IOP was less than 21 mm Hg without oral medication in 16 eyes (80.0%). The only complication was slight bleeding from the punctured trabeculum. This bleeding was completely absorbed within a week.     

Timolol and postoperative intraocular pressure

We studied the effect of timolol instillation at surgery on the acute postoperative pressure rise following extracapsular cataract extraction (ECCE) and posterior chamber lens implantation. The intraocular pressure (IOP) was measured daily during the first week following surgery in 85 eyes. Timolol was instilled immediately following surgery in 34 eyes; the remaining 51 served as controls. The mean preoperative IOP was 18.7 mm Hg in the treated and control groups. The mean IOP on the first day following surgery was 20.0 mm Hg in the timolol group and 20.7 mm Hg in the control group. Twenty-six percent of the timolol group had a pressure greater than 23.0 mm Hg (mean 35.6 mm Hg); 33% of the control group had a pressure greater than 23.0 mm Hg (mean 31.0 mm Hg). The IOP in all treated and untreated patients with ocular hypertension on the first day following surgery returned to normal within three days. Timolol, therefore, had no effect on acute postoperative pressure elevation following ECCE and posterior chamber lens implantation.     

Effect of intraocular aspiration of sodium hyaluronate on postoperative intraocular pressure

A prospective, randomized, masked study was conducted to evaluate whether intraocular aspiration of sodium hyaluronate used in cataract surgery influenced postoperative intraocular pressure (IOP). Ninety-nine patients (105 eyes) underwent uncomplicated extracapsular extractions with posterior chamber intraocular lens implantation using 1% sodium hyaluronate (AMVISC). In 53 eyes, sodium hyaluronate was aspirated from the anterior chamber prior to wound closure. Sodium hyaluronate was left in the anterior chamber of 52 eyes. The IOP of 33 of the patients was measured 4 hours after surgery. No significant difference was found between the pressure in the eyes from which the sodium hyaluronate had been aspirated and the pressure in those from which it had not. The IOP of all the patients was measured on the first postoperative day. The mean 24 hours after surgery was 23.4 mm Hg in the aspirated eyes and 23.1 mm Hg in the not-aspirated group. Thirteen eyes in the aspirated group and 14 in the not-aspirated group had pressures above 30 mm Hg during the first 24 hours after surgery. There were no significant differences in visual outcome, patient discomfort, corneal clarity, anterior chamber inflammation, or subsequent IOPs during 3 months postoperative examination. Aspiration of sodium hyaluronate at the end of cataract surgery does not appear to significantly reduce either the incidence or the degree of postoperative pressure elevations.     

Suitability for day surgery of trabeculectomy and phacotrabeculectomy using 10-0 polyglactin suture

Objective: To evaluate the suitability of trabeculectomy or phacotrabeculectomy as a day case procedure with the objective of keeping the post-operative intraocular pressure (IOP) under control, both short-term and long-term, and post-operative complications at a low level. Method: A total of 27 eyes undergoing trabeculectomy with or without phacoemulsification for either primary open angle glaucoma or chronic angle closure glaucoma were chosen. All of them had surgery as day cases under sub-tenon injection. IOP check was done at baseline, day 1, month 1, month 6 and year 1 on 27 eyes. Post-operative complications directly related to aqueous drainage were noted at day 1. Result: Mean, mode and range of IOP at each level were analysed. Mean pre-operative IOP was 23.34 mmHg. Post-operative IOP was lowest on day 1 (mean 10.03 mm) which stabilised to mean IOP of 16.3 mmHg at year 1. At 1 year the success rate (IOP less than 21 mmHg) was 92.3% without any glaucoma medication; however, if IOP control with medication (less in number than before surgery) is taken into account the success rate was 96%. Post-operative complications were few and transient. Conclusion: Graded control of post-operative IOP was possible using 10-0 polyglactin suture. IOP on day 1 was not very low due to adequate suture tension and at the same time good control of IOP longterm (1 year in this study) was possible due to gradual release of suture tension by slow absorption. This is ideally suited for day surgery.     

Suitability for day surgery of trabeculectomy and phacotrabeculectomy using 10-0 polyglactin suture

Objective: To evaluate the suitability of trabeculectomy or phacotrabeculectomy as a day case procedure with the objective of keeping the post-operative intraocular pressure (IOP) under control, both short-term and long-term, and post-operative complications at a low level. Method: A total of 27 eyes undergoing trabeculectomy with or without phacoemulsification for either primary open angle glaucoma or chronic angle closure glaucoma were chosen. All of them had surgery as day cases under sub-tenon injection. IOP check was done at baseline, day 1, month 1, month 6 and year 1 on 27 eyes. Post-operative complications directly related to aqueous drainage were noted at day 1. Result: Mean, mode and range of IOP at each level were analysed. Mean pre-operative IOP was 23.34 mmHg. Post-operative IOP was lowest on day 1 (mean 10.03 mm) which stabilised to mean IOP of 16.3 mmHg at year 1. At 1 year the success rate (IOP less than 21 mmHg) was 92.3% without any glaucoma medication; however, if IOP control with medication (less in number than before surgery) is taken into account the success rate was 96%. Post-operative complications were few and transient. Conclusion: Graded control of post-operative IOP was possible using 10-0 polyglactin suture. IOP on day 1 was not very low due to adequate suture tension and at the same time good control of IOP longterm (1 year in this study) was possible due to gradual release of suture tension by slow absorption. This is ideally suited for day surgery.     

Extracapsular cataract extraction and posterior chamber lens implantation in controlled open-angle glaucoma

A consecutive series of 103 eyes, 37 with controlled simple glaucoma (SG) and 66 with capsular glaucoma (CG), underwent extracapsular cataract extraction (ECCE) and posterior chamber lens (PC-IOL) implantation. Two to 6 weeks after surgery, 48% of the SG eyes and 62% of the CG eyes had visual acuities better than 0.4, as compared with 8% and 3%, respectively, preoperatively. The corresponding figures after 12 to 43 months in the SG eyes were 62%, and after 14 to 38 months in the CG eyes, 55%. A slight increase of mean intraocular pressure (IOP), from 19.0 +/- 4.8 mm Hg to 25.3 +/- 13.3 mm Hg in the SG eyes, and from 19.0 +/- 3.9 mm Hg to 24.5 +/- 9.6 mm Hg in the CG eyes occurred 1 to 2 weeks after surgery; at 2 to 6 weeks the mean IOPs had returned to preoperative levels: 18.1 +/- 6.4 mm Hg in the SG eyes and 18.4 +/- 5.9 mm Hg in the CG eyes. After a mean of 26.5 months (range, 12 to 43 months), IOP had decreased to 17.3 +/- 2.9 mm Hg in the SG eyes; and after 24.2 months (range, 14 to 38 months) to 17.6 +/- 5.7 mm Hg in the CG eyes. The need for glaucoma medication was diminished at 2 to 6 weeks after surgery: IOP was controlled (less than 21 mm Hg) without glaucoma medication in 43% of the SG, and in 50% of the CG eyes (preoperatively, all of the SG and 89% of the CG eyes required medication).(ABSTRACT TRUNCATED AT 250 WORDS)     

持续高眼压状态下手术治疗急性闭角型青光眼33例

目的探讨对降眼压治疗效果不佳的闭角型青光眼在高眼压状态下行手术治疗的疗效。方法回顾性分析笔者所在医院2007年5月～2010年10月治疗的33例33眼应用药物不能控制眼压的急性闭角型青光眼患者,所有患者均行复合式小梁切除术治疗。术后随访6～12个月。结果所有患者手术均顺利完成,术中术后均未出现严重并发症,术后视力获得明显的提高;术后1周所有患者眼压均在8～11mmHg,经6～12个月随访,患者眼压基本控制在14.36～21.58mmHg。结论原发性闭角型青光眼持续高眼压状态下的复合式小梁切除术是安全有效的。手术治疗的术前、术中、术后都应积极处理高眼压,提高手术的成功率,预防和减少术中及术后并发症的发生。     

Intraocular pressure after cataract surgery with Healon

We studied the intraocular pressure (IOP) following extracapsular cataract extraction and posterior chamber lens implantation in 75 cases. Sodium hyaluronate (Healon) was used in all cases. In 40 cases, Healon was left in the eyes; in 35, the eyes were irrigated to remove Healon from the anterior chamber. When Healon was left in the eyes, 35% had an IOP increase of greater than or equal to 20 mm Hg during the initial ten hours, compared to 11% of the group in which Healon was irrigated out. Twenty hours after surgery, the irrigated eyes had an average lower IOP than the nonirrigated eyes, 15.6 mm Hg versus 23.8 mm Hg.     

Transconjunctival Nd:YAG laser revision of failing trabeculectomy

We used a Q-switched Nd:YAG laser delivered transconjunctivally to restore filtration to a failing trabeculectomy of a 51-year-old black woman with primary open-angle glaucoma and uncontrolled intraocular pressure (IOP) on maximally tolerated anti-glaucoma medical therapy. Initially, the Nd:YAG laser was directed via a goniolens at the interface of the trabeculectomy flap and scleral bed. This attempt to restore filtration was unsuccessful. In two separate treatment sessions the Nd:YAG laser was directed transconjunctivally onto the visible trabeculectomy flap margins, followed by focusing the laser onto the gray-white episcleral fibrous tissue overlying the scleral flap. During the last transconjunctival treatment, the bleb elevated immediately and the IOP decreased from 30 mm Hg to 18 mm Hg. These effects have been sustained over 3 months of follow-up.