反折式小梁切除术治疗青光眼

目的　改进常规小梁切除术,减少术后滤过道阻塞。方法　在常规小梁切除术的基础上,对拟切除的包括小梁在内的深层巩膜组织(4.0mm×1.5mm)不完全切除,而是保留一端,将其垂直扭转反折缝于其后方的深层巩膜组织之上,利用其隆起特点防止术后滤过道阻塞。结果　术后随访12～36个月,平均23.5个月。治疗组33例(38只眼),眼压从术前(25.41±2.41)mmHg(1mmHg=0.133kPa)降至术后(14.74±0.90)mmHg。对照组33例(40只眼),眼压从术前(24.96±1.35)mmHg降至术后(19.40±1.43)mmHg,治疗组手术成功率94.7％,对照组手术成功率77.5％。结论　采用反折式小梁切除术治疗青光眼,能有效减轻术后滤过道阻塞,从而有效控制眼压,减少复发,该术式易操作,且安全、有效。

Reversed trabeculectomy for treatment of glaucoma

OBJECTIVE: To reduce the postoperative blocking of the filtration canal in routine trabeculectomy with modification. METHODS: The modification of the procedure of routine trabeculectomy was that one end of the 4.0 mm x 1.5 mm deep layer scleral tissue including part of trabecular meshwork was not cut. Instead, the free end of the strip of deep scleral tissue was vertically rotated and sutured on the deep layer of the scleral bed posterior to it. The projection of the strip was utilized to prevent postoperative blocking of filtration canal. RESULTS: The mean period of postoperative follow-up was 23.5 months (range, 12 -- 36 months). In the treatment group (38 eyes of 33 cases), the intraocular pressure (IOP) was lowered from preoperative (25.41 plus minus 2.41) mm Hg to postoperative (14.74 plus minus 0.90) mm Hg. The IOP was lowered from preoperative (24.96 plus minus 1.35) mm Hg to postoperative (19.40 plus minus 1.43) mm Hg in the control group (40 eyes of 33 cases). The success rates were 94.7% and 77.5% in the treatment and control group respectively. CONCLUSIONS: The modified trabeculectomy is safe, easy to perform, and can effectively relieve the postoperative blocking of the filtration canal, control postoperative IOP and reduce postoperative recurrence.