复合式小梁切除术联合睫状体冷凝治疗晚期新生血管性青光眼

目的探讨复合式小梁切除术联合睫状体冷凝治疗晚期新生血管性青光眼的疗效。方法晚期新生血管性青光眼16例（16眼）．一次性施行180°睫状体冷凝联合复合式小梁切除术．观察术后眼压、新生血管消退情况及手术并发症。结果术后随访6—48个月,视力均无明显改善,平均眼压自（57．48±10．00）mmHg降至（12．46±4．36）mmHg,控制在21mmHg以下者13眼（占80．12％）,手术眼压控制较好。结论一次性施行复合式小梁切除术联合睫状体冷凝对晚期新生血管性青光眼有较好的长期疗效。     

改良复合式小梁切除术治疗青光眼的临床观察

目的 观察改良复合式小梁切除术治疗青光眼的临床疗效。方法 随机选择26例（36眼）青光眼患者施行复合式小梁切除术（观察组）；随机对照组32例（38眼）行单纯小梁切除术，分析比较两组术后眼压、滤过泡及前房深度。结果 术后第1天浅前房发生率观察组为2．8％，明显低于对照组21．1％（P〈0．05）。随访一年，观察组功能性滤过泡占88．9％，较对照组功能性滤过泡65．8％为多（P〈0．05）；以不用降眼压药物眼压控制在21mmHg（1mmHg=0．133kPa）以下为手术成功标准，观察组手术成功率为94．4％，较对照组71．1％为高（P〈0．05）。结论 改良复合式小梁切除术提高了手术成功率，可有效地控制滤过量而减少术后浅前房的发生。     

晚期青光眼复合式小梁切除术的疗效分析

目的 探讨青光眼晚期管状视野复合式小梁切除术的疗效.方法 对72例(91只眼)青光眼晚期管状视野患者行复合式小梁切除术,结果术后平均随访12个月.①眼压:术前(35.41±7.29)mmHg,术后(13.95±4.12)mmHg,采用配对t检验差异有统计学意义(P<0.01).②视力:有8只眼较术前提高,79只眼视力无变化,4只眼术后视力下降,无1例发生术中术后视功能丧失,其差异无统计学意义(P>0.05).③视野:有4只眼视野较术前扩大,76只眼视野无变化,11只眼视野缩小,其差异无统计学意义(P>0.05).④滤过泡:全部病例滤过泡均呈弥散隆起.结论 复合式小梁切除术是治疗青光眼晚期管状视野的有效方法,能较好地保存残存的视功能.     

青光眼滤过手术失败后复合式小梁切除术的疗效分析

目的探讨青光眼滤过手术失败后行复合式小梁切除术的治疗效果。方法采用复合式小梁切除术对青光眼小梁切除术失败的40例（58眼）进行再次手术（复合式小梁切除术）治疗。术后随访16-26月。结果手术前平均眼压为（36.62±9.02）mmHg,术后眼压平均为（10.21±4.12）mmHg。治疗前后平均眼压的差异有统计学意义（P〈0.05）。再次手术51眼（87.93%）获得成功。52眼（89.66%）为功能性滤泡。结论青光眼滤过手术失败后采用复合式小梁切除术进行治疗效果良好。     

高眼压状态下的复合式小梁切除术

目的 研究闭角型青光眼持续高眼压状态下复合式小梁切除术的临床效果。方法 对15例16眼眼压控制不良的闭角型青光眼进行了前房穿刺联合复合式小梁切除术。结果16眼手术顺利，无脉络膜下爆发性出血等术中并发症发生；术后随访5～12月，12例(13眼)眼压控制在6～21mmHg(1mmHg=0．133kPa)，其中1眼需局部加用降眼压药物。手术成功率81．25％。3眼出现低眼压(≤5mmHg)发生率18．75％。16眼均为功能性滤过泡，其中5眼为薄壁泡，发生率31．25％。结论 持续高眼压状态下的闭角型青光眼运用复合式小梁切除术是安全有效的。     

复合式小梁切除术治疗非穿透小梁切除术后眼压失控

目的：探讨复合式小梁切除术治疗原发性开角型青光眼行非穿透小梁切除术后眼压失控（眼压升高）的长期疗效与安全性。方法：回顾分析了2006-03/2011-07非穿透小梁切除术治疗原发性开角型青光眼术后眼压失控（眼压升高）再次行小梁切除术的连续随访患者13例25眼。青光眼术后再次眼压异常升高,均属于难治性青光眼,我们采取复合式小梁切除术,对于仅存中心视岛及管状视野患眼,手术在表面麻醉联合球筋膜浸润麻醉下实施。主要检查指标：手术前后眼压、视力、角膜水肿情况、滤过泡特征、前房深浅及其它并发症。结果：随访3mo～5a,非接触眼压测定术前眼压28～52mmHg,术后眼压11.7～18mmHg,术后3mo,眼压为145mmHg,眼压以≤21mmHg为成功标准。术后3mo,视力提高3眼（12%）,视力不变17眼（68%）,视力下降5眼（20%）;术后21眼角膜均变清亮;功能性滤过泡22眼（80%）,有3眼为非功能性滤过泡,眼压再次高于21mmHg,二次进行复合式小梁切除术后眼压控制在21mmHg以下;术后有15眼（60%）出现前房轴深在1.5～2CT间,均自行恢复;术中、术后有10眼（40%）出现不同程度的前房出血,经对症治疗后均已吸收;术后有5例5眼（20%）出现房水闪辉,经散瞳及典必殊滴眼液进行眼局部频点后房水闪辉完全消失,未发生眼内炎等并发症。结论：小梁切除术目前仍是可挽救有视力眼的青光眼最经典、最有效的方法;复合式小梁切除术是原经典手术方式的进一步发展;青光眼术后眼压再次异常升高均属于难治性青光眼,原发性开角型青光眼行非穿透小梁切除术后眼压失控应用复合式小梁切除术再次治疗,证实安全有效,长期疗效满意,是弥补非穿透小梁切除术眼压失控（升高）后有效的治疗措施,并且可以一眼多次手术;有效地保护仅存的视力,维持了一定的视功能;晚期原发性开角型青光眼不适合非透性小梁手术。     

超声乳化人工晶体植入联合小梁切除术的临床观察

目的 探讨超声乳化人工晶体植入联合小梁切除术的方法，评价其疗效。方法 对21例（21眼）青光眼合并白内障施行超声乳化人工晶体植入联合小梁切除术。结果 术后随访3-24个月，21眼眼压均〈21mmHg（1mmHg=0．133kPa），术后矫正视力≥0．5者12例（57．1％），且无严重并发症出现。结论 超声乳化人工晶体植入联合小梁切除术安全有效，适用于青光眼合并白内障。     

青光眼白内障联合手术治疗白内障继发青光眼

目的探讨白内障继发青光眼进行白内障青光眼联合手术的效果。方法28例（28只眼）白内障继发青光眼完成了超声乳化吸出及人工晶状体植入联合巩膜瓣下小梁切除术。结果术前视力〈0．1者22只眼,0．1～0．3者6只眼。术后视力〈0．1者13只眼,0．1～1．0者15只眼。术前平均眼压（34．30±9．32）mmHg,术后平均眼压（16．42±5．36）mmHg（1mmHg=0．133kPa）。25眼眼压降至正常范围,3眼经药物治疗达到正常范围。并发症主要是角膜水肿和浅前房。术后随访3～6个月。结论超声乳化吸出及人工晶状体植入联合巩膜瓣下小梁切除术对于白内障继发青光眼是安全和有效的。     

难治性青光眼小梁切除术术中调整巩膜瓣缝线的效果

目的探讨小梁切除术术中调整巩膜瓣缝线联合应用丝裂霉素C（MMC）治疗难治性青光眼的效果。方法对58例（58眼）难治性青光眼采取小梁切除术，术中调整巩膜瓣缝线并应用MMC。观察术后视力、滤过泡、角膜、前房、晶状体、眼底、眼压等。随访6～18月。结果术后有50眼（86．21％）的眼压≤21mmHg；3眼（5．17％）加用眼局部降眼压药物治疗，眼压〈30mmHg；5眼（8．62％）的眼压无改善。结论在小梁切除术术中调整巩膜瓣缝线联合应用MMC是治疗难治性青光眼的有效方法之一。     

复合式小梁切除术的临床观察

目的探讨复合式小梁切除术治疗原发性青光眼的疗效。方法观察组50眼行复合式小梁切除术；对照组52眼行单纯小梁切除术。分析比较两组术后眼压、视力、前房、滤过泡及手术并发症。结果术后1年眼压控制率：观察组为96．00％；对照组为67．31％。两组比较差异有统计学意义（P〈0．001）。功能性滤过泡观察组为94．00％，较对照组63．46％为多（P〈0．001）。术后第1天浅前房发生率观察组为4．00％，明显低于对照组的32．69％。结论复合式小梁切除术可减少手术并发症，提高手术成功率。     

晚期原发性青光眼高眼压状态下手术治疗效果分析

目的评价晚期原发性青光眼持续高眼压状态下施行小梁切除术的手术效果。方法34例（36眼）晚期原发性青光眼行结膜表面浸润麻醉,开放前房后,慢慢释放房水后再行小梁切除手术,术中局部应用丝裂霉素。结果术后随诊观察6—12个月,术后有27眼视力增加,7眼保持其原有视力,2眼视力下降。眼压均控制在21mmHg以下。术后结膜滤过功能良好,未发现包裹性或局限性的无功能滤过泡。视野术前能检查的有20眼术后全部扩大。结论对晚期原发性青光眼改变传统的麻醉方法并联合丝裂霉素行小梁切除术,可以有效降低眼压。     

Impact of intraocular pressure after filtration surgery on visual field progression in primary open-angle glaucoma

PURPOSE: To compare visual field progression after trabeculectomy in eyes showing a postoperative intraocular pressure (IOP) less than or equal to 16 mmHg and eyes with an IOP of 17 to 21 mmHg. METHODS: A retrospective cohort study design was used. A total of 101 eyes of 101 consecutive patients undergoing trabeculectomy for primary open-angle glaucoma (POAG) with a postoperative IOP less than or equal to 21 mmHg were divided into two groups: Group 1 included eyes showing a postoperative IOP less than or equal to 16 mmHg at all visits and Group 2 included eyes with a postoperative IOP between 17 and 21 mmHg. In turn, each of these groups was divided into two subgroups according to whether treatment was required for IOP control. Glaucomatous visual field control during follow-up was compared between the subject groups. RESULTS: Kaplan-Meier analysis revealed glaucomatous visual field control in 98.53% of the eyes in Group 1 and 89.06% of those in Group 2 at 5 years, the difference between the groups being significant. CONCLUSIONS: Glaucomatous disease progression is less frequent when IOP is less than or equal to 16 mmHg in all the follow-up visits after trabeculectomy. The results indicate a definite benefit of low IOP in visual field control.     

晚期青光眼手术治疗的探讨

目的　探讨晚期青光眼手术治疗效果和术中暂时性视力丧失的原因及预防。方法　对 36例 (48眼 )管状视野或颞侧视岛青光眼患者施行小梁切除术 ,观察和分析视力、视野、眼压变化。结果　出院时视力提高 2 6眼 (54 2 % ) ,不变 2 0眼 (41 7% ) ,眼压 <2 1mmHg(1mmHg=0 .1 33kPa) 4 2眼 (87 5 % )。随访 1 6例 (2 6眼 ) ,平均时间 1 0月 ,视力提高和不变2 3眼 (88 5 % ) ,眼压 <2 1mmHg2 2眼 (84 6 % ) ,1 4眼术后 1年复查视野 ,较术前改善和无变化 1 2眼 (85 7% )。结论　手术治疗晚期青光眼对于维持残余视功能是积极有效的     

The long-term outcome of trabeculectomy in advanced glaucoma

PURPOSE: We evaluated retrospectively the surgical outcome of trabeculectomy in patients with advanced glaucoma. METHODS: We studied 18 eyes of 18 patients with advanced glaucoma (mean age: 71.2 years, mean follow-up period: 41.1 months). In each eye, the visual field was at stage 5 of Aulhorn-Greve's classification before surgery. RESULTS: Two eyes showed extreme hypotony (< 2 mmHg) 3 days after surgery and lost the central visual field permanently. Another 2 of 4 eyes which could not be maintained below 15 mmHg showed a worsening of visual field disturbance within stage 5 of Aulhorn-Greve's classification. The final visual acuity was 0.7 or better in 9 eyes (50.0%), 0.1 or worse in 2 eyes (11.1%). The final intraocular pressure (IOP) was below 10 mmHg without and with medication in 8 eyes (44.4%) and 2 eyes (11.1%) respectively. The final IOP was below 15 mmHg without and with medication in 11 eyes (61.1%) and 3 eyes (16.7%) respectively. Postoperative complications were observed in 4 eyes (22.2%). CONCLUSIONS: The cause of postoperative central visual field worsening was associated with extreme intraocular hypotony (2 mmHg) rather than IOP elevation due to bleb dysfunction. This surgery may be effective as 14 eyes (78%) were able to maintain visual acuity and the central visual field.     

双切口小梁切除与超声乳化联合手术治疗青光眼合并白内障

目的评价双切口小梁切除联合超声乳化人工晶状体植入术治疗青光眼合并白内障的安全性及效果。方法使用双切口式小梁切除联合超声乳化人工晶状体植入术治疗各种青光眼合并白内障52例（54眼）,分析手术前、后视力和眼压变化,术中及术后并发症情况。结果随访6～12个月,术后视力改善明显,矫正视力≥O．3者38眼,占70．4％,眼压由术前平均（31．30±6．37）mmHg降为术后平均（14．97±2．44）mmHg,术中及术后无严重并发症发生。结论双切口小梁切除联合超声乳化人工晶状体植入治疗青光眼合并白内障是安全、有效的方法。     

玻璃体切割联合超全视网膜光凝、白内障摘出术治疗新生血管性青光眼

目的探讨玻璃体切割联合超全视网膜光凝及白内障摘出治疗新生血管性青光眼的疗效。方法对我院收治的15眼新生血管性青光眼施行玻璃体切割联合超全视网膜光凝及白内障摘出术,观察术后眼压、视力、新生血管消退情况,并与文献报道的玻璃体切割联合小梁切除术后眼压结果比较。术后随访6～18个月。结果末次随访时眼压平均18mmHg(13～25mmHg,1kPa=7.5mmHg),13眼(86.7%)眼压≤21mmHg,另2眼(13.3%)眼压(22mmHg、25mmHg)稍高于正常水平,但较术前(50mmHg、65mmHg)明显下降。末次随访时11眼(73.3%)视力提高,4眼(26.7%)视力不变。所有患眼新生血管消退。与文献报道的玻璃体切割联合小梁切除术相比,二者手术前后眼压差类似,差异无统计学意义(P>0.05)。结论玻璃体切割联合超全视网膜光凝及白内障摘出术可较好地治疗新生血管性青光眼,其治疗效果与联合小梁切除术类似。     

Success criteria and success rates in trabeculectomy with and without intraoperative antimetabolites using intensified postoperative care (IPC)

Purpose: To define the success rate of trabeculectomy for surgical treatment of glaucoma under intensified postoperative care (IPC) conditions in cases of severe visual field damage or progression of visual field loss. Methods: In a retrospective study, we evaluated the outcome of trabeculectomy in 99 eyes of 99 patients from October 1995 to June 1997. In 23 eyes, antimetabolites were used intraoperatively. Regarding intraocular pressure (IOP), success was defined as lowering the preoperative, maximally treated IOP by more than 20% in addition to a postoperative IOP level lower than 21 mmHg without using further glaucoma medication. Success rate was defined by stabilisation of visual acuity and visual field in addition to IOP reduction. Results: The postoperative IOP was 14.7 mmHg (±3.4 mmHg) following standard trabeculectomy (preoperative IOP 24.3±6.7 mmHg) and 15.8 mmHg (±4.9 mmHg) following trabeculec-tomy with intraoperative anti- metabolites (preoperative IOP 27.0±9.5 mmHg). The success rate concerning the IOP was 83% in standard trabeculectomy and 74% following trabeculectomy with intraoperative antimetabolites. The visual acuity showed stabilisation in 93% of cases following standard trabeculectomy and in 100% following trabeculectomy with intraoperative antimetabolites. The visual field showed stabilisation according to the Aulhorn criteria in 95% and 94% of cases following standard trabeculectomy and trabeculectomy with intraoperative antimetabolites, respectively. The total success rate using all criteria together was 76% following standard trabeculectomy and 74% following trabeculectomy with intraoperative antimetabolites. Conclusion: The overall outcome after trabeculectomy is good with appropriate follow-up and timely decisions for after- treatment to ensure good development of the filtering bleb. Received: 24 June 1999 Revised: 6 January 2000 Accepted: 18 January 2000     

超声乳化与小梁切除治疗闭角型青光眼的对比

目的 对比研究超声乳化人工晶状体植入术与小梁切除术对初次发作的原发性急性闭角型青光眼的疗效。方法 将58例（58眼）初次发作的原发性急性闭角型青光眼合并白内障者随机分为两组，每组29例（29眼），A组行超声乳化吸出人工晶状体植入术，B组行穿透性小梁切除术。术后随访3～6月。结果 术后随访期间两组视力均有提高，以A组提高明显。A组术后前房深度增加；B组术后前房深度减少，并且有5例术后早期发生了浅前房。术后两组眼压均比术前明显降低，早期以B组下降明显，A组有6例术后1天眼压高于21mmHg（1mmHg=0．133kPa），经局部用药后降至正常。结论 初次发作的合并有白内障的原发性急性闭角型青光眼，若无明显前房角粘连，经药物治疗眼压控制不佳者，采用晶状体超声乳化吸出人工晶状体植入术可以有效地降低眼压恢复视功能，且术后并发症较传统的小梁切除术为少。     

小切口小梁切除术的临床观察

目的：探讨不打开结膜囊的小切口小梁切除术治疗原发性青光眼的效果。方法：对46例（64眼）行上述手术的原发性青光眼患者的眼压,视力,滤过泡及手术并发症进行回顾性总结。结果：追踪观察末期（平均16个月）,43例（93．47％）患者的眼压控制在正常范围,平均眼压为17．30mmHg(2.31kPa),没有发生明显的手术并发症。