青光眼手术并发症的探讨

青光眼手术是治疗青光眼的主要方法。而并发症的发生是青光眼手术失败的重要原因，尽量减少手术并发症的发生，一旦发生进行正确而灵活的处理，是青光眼手术成功的关键。本文提出减少青光眼手术并发症的措施和对一些并发症的处理方法。     

表麻加结膜下浸润麻醉在抗青光眼手术中的临床应用

目的 探讨表麻加结膜下浸润麻醉进行青光眼手术的可行性，分析其安全性。方法 对49例63眼青光眼手术用倍诺喜(0．4％盐酸奥布卡因)眼液表面麻醉和2％利多卡因结膜下浸润麻醉。结果 用于青光眼手术，均顺利完成手术。不但镇痛效果好，节约手术时间，避免球后麻醉的并发症，缩短手术时间，而且减少对晚期青光眼手术的风险。结论 表麻加结膜下浸润麻醉对青光眼手术是一种安全、有效及简便易行的麻醉选择，尤其是对于晚期青光眼值得推广使用。     

青光眼术后并发症的中西医结合疗法

青光眼术后并发症的中西医结合疗法解放军第９７医院眼科（江苏徐州２２１００４）邵新香青光眼是眼科常见病，确诊后适宜手术治疗者，应争取早期手术。现代显微手术的发展，使得青光眼手术成功率有较大提高，由于种种原因，术后并发症也时有发生，若不及时处理，对手术效...     

非穿透性小梁手术的研究进展

非穿透性小梁手术是一类新型的抗青光眼手术，适用于开角型青光眼。本文主要介绍了非穿透性小梁手术的主要术式，手术方法和手术效果，大量的临床资料表明非穿透性小梁手术效果稳定，并发症较少，有望成为一种治疗开角型青光眼的理想手术。     

玻璃体视网膜手术与青光眼

随着近年来玻璃体视网膜手术器械和技术的提高，其手术适应证不断扩大。西方主要综述玻璃体视网膜手术治疗青光眼的有关进展，同时也提出玻璃体视网膜手术后继发性青光眼的可能，目的在于正确应用玻璃体视网膜手术治疗青光眼，并注意防治其并发症。     

结膜下麻醉与抗青光眼手术

目的 评价抗青光眼手术单纯应用结膜下麻醉的可行性，安全性和效果。方法 观察了116例（138眼）不同类型青光眼在球结膜麻醉下进行的抗青光眼手术，分析了术中术后的注意事项，麻醉效果及并发症。结果 所观察的手术病例全部在球结膜麻醉下顺利完成，个别病例术中有轻微胀痛感，但不影响手术操作。结论 单纯结膜下麻醉抗青光眼手术是可行的、安全有效的，并发症少，但要在其他麻醉方法，熟练的手术操作基础上开展。     

顽固性青光眼引流植入物的手术治疗

本文回顾了顽固性青光眼引流植入物手术治疗的近期文献。重点介绍了顽固性青光眼的难治性的组织病理学机制，引流植入物的设计原理和基本构造，手术的基本步骤，并发症和治疗效果。结论认为，对于顽固性青光眼，引流植入物手术不失为一种有效的治疗方法。     

抗青光眼术后前房延缓形成11例分析

前房延缓形成是抗青光眼术后常见并发症，历来受到眼科医师关注。因为处理不当，不仅影响手术效果，还可导致严重的并发症。笔者自１９８４～１９９７年共行各种抗青光眼手术９６只眼，有１１只眼发生了前房延缓形成。１材料与方法１１对象本组抗青光眼手术病例共７５例...     

青光眼滤过手术并发角膜后弹力层脱离探讨

青光眼小梁切除手术中合并使用前房穿刺技术已广泛开展，青光眼滤过手术引起角膜后弹力层脱离是青光眼手术中少见而严重的手术并发症，本文探讨总结青光眼小量切除手术引起角膜后弹力层脱离的原因、术中情况和术后处理情况，建议改良前房穿刺技术，并提供处理术后角膜后弹力层脱离使其恢复的成功经验。     

顽固性青光眼引流植入物的手术治疗

本文回顾了顽固性青光眼引流植入物手术治疗的近期文献。重点介绍了顽固性青光眼的难治性的组织病理学机制、引流植入物的设计原理和基本构造、手术的基本步骤、并发症和治疗效果。结论认为，对于顽固性青光眼，引流植入物手术不失为一种有效的治疗方法。     

The risk profile of glaucoma filtration surgery.

Glaucoma surgery has evolved over the past 30 years from the full-thickness procedure to the guarded filtration procedure. However, many of the risks and complications attendant with the full-thickness procedure, including endophthalmitis, hypotony, cataract progression, and filtration failure, continue to plague the glaucoma surgeon performing the guarded filtration procedure, although at lower incidences. With proper modification of technique, such as with postoperative bleb titration and use of adjunctive antifibrotic therapy based on prognosticators for failure, the success rates of trabeculectomy reoperations can approach those of primary trabeculectomy. Such risk factors for failure include African-American race, higher preoperative intraocular pressures, previously failed filters, younger age, and uveitic and neovascular glaucomas. In this paper, we review a number of studies that analyze the risks, complications, and long-term results of glaucoma filtration surgery and discuss different surgical recommendations based on risk factors for failure as well as for performing concomitant cataract and glaucoma surgery.     

Update on antifibrotic use in glaucoma surgery, including use in trabeculectomy and glaucoma drainage implants and combined cataract and glaucoma surgery

PURPOSE OF REVIEW: This paper summarizes the use of antifibrotic agents adjunctive to glaucoma surgery, reviews recently published studies that address current use of these antifibrotics, and reviews new methods of wound modulation. RECENT FINDINGS: The use of antifibrotic agents, namely, 5-fluorouracil and mitomycin C, in conjunction with glaucoma surgery has resulted in lower postoperative intraocular pressures after trabeculectomy or combined cataract and glaucoma surgery. Mixed results have been seen when these agents are used with glaucoma drainage device surgery. The use of antifibrotic agents has also created and increased complications. Therefore, methods of antifibrotic use have become more refined and modified for specific circumstances. Promising new wound modulation agents, such as CAT-152, are currently under study. SUMMARY: Antifibrotics are potent adjuncts to glaucoma surgery, but along with their beneficial use are risks that need to be considered. While we continue to look for more efficacious agents and methods to treat glaucoma, we must continue to modify techniques with the individual patient's best interest in mind.     

How to prevent and treat glaucoma surgical failures?

Although many improvements have been made to filtering surgery in glaucoma, some post operative complications do occur quite often. Patients need careful and frequent follow-up to assess and treat the early complications that may occur after glaucoma surgery. Over the medium and long term, insufficient verification of the intra ocular pressure signals the failure of the initial surgery. In this article, we review the diagnostic tools useful for detecting the early and late failures of glaucoma surgery and we provide recommendations for their treatment.     

抗青光眼手术的利与弊

 青光眼是终生性疾病和不可逆性致盲眼病,即使经过恰当治疗仍不能恢复原有的正常视功能,只能延缓病情进展,而不能将其治愈。目前青光眼的治疗主要包括药物、激光和手术手段,因人而异地将眼压降低,尽量达到每位患者的“目标眼压”。目前常用的抗青光眼手术是小梁切除术,能明显降低眼压,控制眼压波动,成功率较高,但仍存在一定风险和难以预料的手术并发症,医生和患者均需要慎重选择。影响手术效果的因素较多,尤其是难治性青光眼更需要医生积极妥当处理。（眼科,2014, 23： 288-后插II）     

Surgical indications in coexisting cataracts and glaucoma

Cataract surgery in glaucoma patients remains a controversial subjects. Indication of surgery depends on a lot of clinical parameters: diagnosis, state, evolution of glaucoma as well as compliance with medical treatment--surgical procedures of cataract and glaucoma--sites of the surgery--use of antifibrosis agents and surgeon's experience. As cataract extraction alone decreases the intraocular pressure in open angle glaucoma and mainly in uncomplicated closed angle glaucoma and trabeculectomy alone reduces the intraocular pressure more than combined surgery with less complications we recommended the following surgical options: Cataract extraction alone in patients with controlled open angle glaucoma and in patients with closed angle glaucoma. A two step procedure: filtering surgery followed by cataract extraction in patients with poorly controlled open angle glaucoma or mixed closed angle glaucoma. Ambulatory surgery and topical anesthesia permit a two stages surgery with less inconveniences. A combined procedure in patients with a chronic closed angle glaucoma where filtering procedure alone is associated with important complications. Actually, the best surgical cataract procedure is phacoemulsification with a small supero-corneal incision and implantation of a foldable intraocular lens. The best filtering procedure remains trabeculectomy, or the new non penetrating trabecular surgery for experimented surgeons, in the superior quadrant. In the future new surgical procedures and new safe and non toxic pharmacologic drugs which modulate wound healing could be found in order to increase the efficacity and indications of combined surgery.     

Combined phacoemulsification and goniotrephination on eyes with primary open-angle glaucoma and classical pseudoexfoliation glaucoma

Background: Combined glaucoma and cataract operation has been demonstrated to be effective in controlling IOP and increasing visual acuity. Because of the differences between patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXEG), for cataract and glaucoma surgery alone we evaluated the effects and complications for simultanous surgical management.     

Views of glaucoma patients on aspects of their treatment: an assessment of patient preference by conjoint analysis

PURPOSE: To determine by conjoint analysis which factors in the management and treatment of glaucoma were of most importance to patients and to relate these factors to the patient's clinical glaucoma condition. METHODS: An interview-based study was performed. Demographic and visual function data are recorded. Participants completed the Visual Function Questionnaire-25 and ranked 10 hypothetical patient scenarios that contained different risks of moderate visual loss, postoperative complications, long-term blindness, use of topical medication, and glaucoma surgery. Conjoint analysis was performed to determine the relative importance of these factors for individuals and the group as a whole. RESULTS: Eighty-two patients were interviewed from two consultants' outpatient clinics. Forty-five were male and 37 female. Seventy-nine were white. The most important factors to patients with glaucoma were the risk of moderate visual impairment and the risk of blindness, with an importance of 38% and 27%, respectively. The use of topical medication had an importance of 11%. Proceeding to surgical intervention (trabeculectomy) had an importance of 15%, and the small risk of visual deterioration after surgery (trabeculectomy) had an importance of 9%. CONCLUSIONS: To patients, the most important factors regarding glaucoma and its treatment are the risks of moderate visual loss (the ability to continue to drive) and long-term blindness. The treatment methods used are of much less importance.     

Hemorrhagic complications from glaucoma surgery in patients on anticoagulation therapy or antiplatelet therapy

PURPOSE: To determine the incidence of and risk factors for hemorrhagic complications in patients on anticoagulation (ACT) or antiplatelet therapy (APT) having glaucoma surgery. DESIGN: Retrospective case-control study. METHODS: Medical records of patients who had glaucoma surgery between July 1, 1998 and March 31, 2005 were reviewed. Patients who either used ACT/APT continuously throughout the perioperative period or discontinued its use prior to surgery were compared to case-matched control patients who were not on such therapies. Patients on ACT/APT who experienced postoperative hemorrhagic complications were compared to those who did not. Outcome measures included hemorrhagic complications and thromboembolic events. RESULTS: Three hundred and forty-seven patients (eyes) who were on ACT or APT prior to glaucoma surgery had a higher rate of hemorrhagic complications than 347 control patients (10.1% vs 3.7%, respectively, P = .002). Patients on ACT had a higher rate of hemorrhagic complications than patients on APT (22.9% vs 8.0%, respectively, P = .003). Patients who continued ACT during glaucoma surgery had the highest rate of hemorrhagic complications (31.8%) when compared to patients who discontinued ACT prior to surgery or patients who used APT alone (P = .001). Hemorrhagic complications following glaucoma surgery were more frequently associated with preoperative ACT, arrhythmia, and higher preoperative and postoperative intraocular pressures (IOP). CONCLUSION: Chronic ACT/APT was associated with a statistically significant increase in the rate of hemorrhagic complications, and perioperative ACT and a high preoperative IOP are potential risk factors for hemorrhagic complications in patients undergoing glaucoma surgery.     

Surgery for diabetic retinopathy

Surgery for diabetic retinopathy addresses late secondary complications of a primary microvascular disease. Since surgery is not a causative therapy, the functional outcome of surgery depends on the degree of retinal ischemia and may be disappointing even in technically and anatomically successfully operated eyes. Typical indications for vitrectomy are vitreous hemorrhage, tractional retinal detachment, combined tractional rhegmatogenous retinal detachment and tractive macular edema. More recently diffuse diabetic macular edema has been shown to improve after removal of an attached vitreous in several cases. Neovascular glaucoma requires aggressive surgical intervention to salvage the eye. Cataract surgery is commonly performed in eyes with diabetic retinopathy. It may however deteriorate diabetic eye disease. Vitreous surgery also has a potential for severe complications in diabetic eyes which can be ameliorated but not eliminated by proper surgical strategies and techniques. The decision for an intervention in diabetic eyes always requires a careful weighing of risks and benefits of surgery.     

角膜屈光手术与青光眼(英文)

角膜屈光手术改变了角膜厚度及曲率,影响术后眼压(in-trocular pressure,IOP)的测量,但动态轮廓眼压计(dynamiccontour tonometer ,DCT)不受此影响。激光原位角膜磨镶术(LASIK)中一过性的IOP升高,增加了视神经损害的风险。同时,功能性滤过泡的存在,影响屈光手术的选择和效果,甚至可能成为手术的禁忌。术后患者使用激素点眼,还可能导致激素性青光眼,故应严密监测术后眼压,并且注意角膜瓣层间积液可能掩盖高眼压。对于已接受屈光手术的青光眼患者,药物治疗方案与其他青光眼患者基本相同。本文就角膜屈光手术对眼压测量、青光眼相关特殊检查的影响、屈光手术并发症及其治疗、手术安全性等问题进行了详细综述。