改良小梁切除术治疗青光眼的临床疗效

目的:探讨改良小梁切除术治疗青光眼的临床疗效。方法:选择40例青光眼患者,随机分为对照组和治疗组,每组20例,治疗组行改良小梁切除术,对照组行小梁切除术。两组患者术后在眼压、视力及前房深度等方面进行比较。结果:治疗组术后在眼压、视力、滤过泡形态及前房深度等方面均明显优于对照组,差异有统计学意义(P<0.05)。结论:改良小梁切除术治疗青光眼减少了手术并发症,疗效显著,值得临床推广应用。     

现代改良小梁切除术治疗青光眼的临床观察

目的探讨现代改良小梁切除术治疗青光眼的效果。方法我院于2003年8月～2006年1月采用现代改良小梁切除术（小梁切除术＋前房穿刺＋丝裂霉素C＋巩膜瓣可调缝线）治疗青光眼患者128例（149眼），术后随访3个月～1年，观察手术前后的眼压、术后切口对合、前房形成、滤过泡形态及并发症的情况。结果术后第1天前房形成138眼（92．6％），浅Ⅰ级前房8眼（5．4％），浅Ⅱ级前房2眼（1．3％），浅Ⅲ级前房1眼（0．7％）。术后7～10天出院时眼压平均为13．2mmHg，6个月眼压平均为15．3mmHg，1年眼压平均为17．5mmHg。出院时滤过泡形态分微小囊状型（Ⅰ型）1眼，弥漫扁平型（Ⅱ型）145眼。可调线依据眼压、前房、滤过情况于术后1～2周时酌情拆除，必要时辅以眼球按摩辅助滤过形成，眼压可以下降2～8mmHg。结论现代改良小梁切除术治疗青光眼安全性高，术后并发症少，疗效确切，适合于基层医院开展。     

改良式小梁切除术治疗青光眼的疗效观察

目的探讨改良式小梁切除术联合丝裂霉素C治疗青光眼的临床疗效。方法应用改良式小梁切除术治疗42例(64眼)各型青光眼,术中一次性使用0.4mg/ml丝裂霉素C,术后随访6～12月,观察其临床疗效及其并发症。结果术后1月检查,58眼(90.6%)术后视力有不同程度的提高;术后1周测眼压,所有病例眼压均有不同程度的下降,有48眼(75.0%)眼压低于21 mmHg,术后6月测眼压,54眼(84.6%)低于21 mmHg;末次随访时,56眼(87.5%)形成弥散扁平的功能性滤过泡,8眼(12.5%)为非功能性滤过泡;总手术成功58眼(90.6%),其中完全成功54眼(84.4%),条件成功4眼(63%),失败6眼(9.4%)。术后主要并发症为:角膜水肿5眼,前房渗出4眼。讨论改良式小梁切除术联合丝裂霉素C治疗青光眼,可有效地减少青光眼术后滤过道瘢痕的形成,充分降低眼压。该方法不需要特殊设备,手术时间短、损伤小,并发症少,手术效果好,是一种安全、有效的治疗青光眼方法。     

改良的小梁切除术

目的探讨一种改良的小梁切除术的疗效。方法手术员微镜下作以角膜缘为基底的结膜瓣,及4x4mm1／3巩膜厚度的浅层巩膜瓣,然后作一中层巩膜瓣,约3X3mm大小1／3巩膜厚度并切除之。作小梁切除、虹膜周切、巩膜瓣固定、球结膜及筋膜囊分层连续缝合。结果200例（280眼）随访6-24月,近期眼压控制率100％,远期为94％,平均眼压15.90mmHg结论改良的小梁切除术,降眼压效果好,是一种较理想的抗青光眼手术方式。     

改良小梁切除术临床疗效观察

0引言常规的小梁切除术是目前最普遍应用的抗青光眼滤过术式,但随着随访时间的延长,滤过手术后眼压失控病例不断增加,手术后2a内的失败率高达15%～30%。其主要原因是手术滤过道瘢痕形成,而再次行滤过手术失败率会更高。因此如何防止巩膜瘘道阻塞保持长时间的功能性滤过作用,已成为小梁切除术研究的难点和热点。我院自2001-10开展改良小梁切除术治疗了几种类型的青光眼15例(17眼),临床观察效果满意,现报告如下。1临床资料在15例青光眼患者中,男5例(5眼),女10例(12眼),年龄41～72岁,其中急性闭角型青光眼14眼,慢性开角型青光眼3眼,术前眼压3.5…     

小梁切除术治疗绝对期青光眼远期疗效观察

采用小梁切除术治疗绝对期青光眼１２５例，其中５７例（５７只眼）随访１－１５年。手术近期成功率９１．２０％，远期成功率９１．２２％，效果满意。对手术并发症等进行了讨论。这种手术方法简单、安全、效果好，是治疗绝对期青光眼的一种较理想的术式。     

改良小梁切除术治疗青光眼的临床分析

目的:采用改良小梁切除术治疗青光眼并观察其临床效果。方法:施行改良小梁切除术18例21眼,术中应用抗代谢药物及可调节缝线,术后观察视力、眼压、前房及并发症。结果:出院时术后视力与术前视力无变化者6例8眼,提高者9例10眼,降低者3例3眼。Ⅰ°浅前房3例3眼,球结膜伤口渗漏4例4眼,经治疗恢复愈合。术后眼压失控者1例1眼,需再次手术。根据术后眼压高低及前房深浅,对可调节缝线进行拆除。部分患者术后视野略有改善。结论:改良小梁切除术术后并发症少,获得了较好的临床效果,但需长期随访。     

原发性青光眼小梁切除术的改良研究

目的观察改良小梁切除手术在原发性青光眼应用的临床效果。方法存65例原发性青光眼进行小梁切除术中只进行表面麻醉及结膜下麻醉,术中采用巩膜瓣可调整缝线。结果麻醉效果良好,无一例因疼痛恐惧而改用其他麻醉方法,麻醉成功率为100％。3眼发生浅前房,经局部加压包扎、散瞳、口服醋氮酰胺等对症治疗后,前房恢复正常。结论改良的小梁切除手术提高了原发性青光眼手术有效率,减少了术中及术后并发症的发生。     

外路小梁切开术治疗先天性青光眼的远期效果

目的 评价外路小梁切开术（Ｌｕｎｔｚ法）治疗先天性青光眼的远期效果。方法 随访２９例（４７只眼）行外路小梁切开术的先天性青光眼患者达５年以上。结果 应用寿命表法分析１次手术成功率：术后６、１２、１８及２４个月分别为７０．２％、６２．８％、５７．５％及５５．３％。眼压再次升高均发生在术后２年之内。１４只眼行２次小梁切开术,成功率为５０．０％,总成功率为７０．２％,成功者中具有１２只眼（３６．０％）裸     

改良垂直式小梁切除术与传统小梁切除术比较

目的 探讨改良垂直式小梁切除术与传统小梁切除术对治疗青光眼疗效的差异。方法 Ⅰ组采用改良垂直式小梁切除术６０例６６眼,Ⅱ组采用传统小梁切除术作对照组４５例４９眼,随访观察３－８周。结果 Ⅰ组术后眼压控制及功能性滤过泡均比Ⅱ组佳。术后并发症比Ⅱ组明显减少。结论改良垂直式小梁切除术操作简便,创伤小,降压效果稳定可靠,是治疗青光眼较好的手术方法。     

Long-term results of non-valved Glaucoma drainage implant surgery and glaucoma drainage implant combined with trabeculectomy

Purpose:

The purpose was to investigate the efficacy and complications of nonvalved glaucoma drainage implant (GDI) surgery and GDI combined with trabeculectomy.

Subjects and Methods:

Serial Japanese patients who received GDI were retrospectively investigated. The survival rate of eyes was analyzed using the Kaplan-Meier method, defining death as: (1) Intraocular pressure (IOP) <6 mmHg, or ≥22 mmHg, and <20% reduction of preoperative IOP, (2) additional glaucoma surgery, (3) loss of light perception. Prognostic factors of age, sex, previous surgery, type of glaucoma, synechial closure, preoperative IOP, type of GDI (single-, double-plate Molteno, Baerveldt 350) and GDI combined with trabeculectomy were investigated employing proportional hazards analysis.

Results:

One hundred and twenty-four eyes of 109 patients aged 53.3 ± 7.8 years old were analyzed. Types of GDI were single-plate (15.3%), double-plate Molteno (71.8%), and Baerveldt 350 (12.9%). The results of survival rate analysis were 86.1, 71.1, 71.1, and 64.6% for 1, 3, 5, and 10 years respectively. Thirty-four eyes (27.4%) died because of uncontrolled IOP (19.4%), loss of light perception (5.6%), and additional glaucoma surgery (2.4%). Single-plate Molteno was the only risk factor for failure. Persistent unphysiological hypotony (0.8%) and bullous keratopathy (5.6%) were observed.

Conclusion:

Nonvalved GDI surgery and GDI combined with trabeculectomy using nonabsorbable tube ligature proved to be an excellent device for any type of glaucoma in Japanese patients. Hypotony and corneal endothelial loss are the most serious complication in the long-term results of our patients.     

小梁切除术治疗近绝对期青光眼的疗效观察

目的观察近绝对期青光眼小梁切除术后的疗效。方法对51例(58眼)近绝对期青光眼小梁切除术前后的眼压,视力及视野对比,明确手术疗效。结果视力提高19眼,不变36眼,3眼下降。眼压1例高于正常范围,其余57眼均等于或小于正常。视野扩大19眼,不变37眼,缩小2眼。结论小梁切除术是近绝对期青光眼治疗的安全,有效,经济的选择。     

改良垂直式小梁切除术治疗青光眼的疗效观察

采用改良垂直式小梁切除术，对２５例４１眼青光眼患者治疗，随访观察３～８月，认为此术式改良在直视下，能充分而准确地切除术小梁结构，并避免了术后小梁窗口的变形，加强了球内引流效果，此式术操作简便，创伤小，术后并发症少，降眼压效果稳定可靠，滤过泡扁平美观，有推广和进一步研究价值。     

现代复合式小梁切除抗青光眼术的临床观察

目的 探讨现代复合式小梁切除术治疗青光眼的效果。方法 随机选择44眼行现代复合式小梁切除术;随机对照42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 本组病例术后第1天浅前房发生率观察组为4.5％,明显低于对照组21.4％(P<0.05);1年后随访61眼(观察组33眼,对照组28跟),观察组功能型滤过泡占84.8％较对照组的60.7％为多(P<0.05)。不用任何抗青光眼药物眼压<21mmHg(1mmHg=0.133kPa)者为手术成功标准,观察组1年后手术成功率为93.9％较对照组的71.4％为高(P<0.05)。结论 现代复合式小梁切除术可减少术后并发症,提高手术成功率。     

显微镜下小梁切除术治疗青光眼疗效观察

目的：观察显微镜下小梁切除术远期疗效。方法：对实施小梁切除术31例(37眼)进行临床总结,术后的早期散瞳,术中精确定位,巩膜瓣缝合适中,对术前眼压控制不良,做前房穿刺口。结果：随访2a,手术成功29例(35眼),失败2例(2眼)。结论：显微镜下小梁切除术并发症少,手术成功率高。     

Outcomes of trabeculectomy in juvenile open angle glaucoma

Purpose:

This study was aimed at reporting the outcomes of trabeculectomy in primary juvenile open angle glaucoma (JOAG).

Design:

This study was a retrospective noncomparative case series.

Materials and Methods:

We included 60 eyes of 41 JOAG patients who underwent primary trabeculectomy without mitomycin-C (MMC) between 1995 and 2007. The primary outcome was success, defined as complete, if intraocular pressure (IOP) was >5 and ≤21 mmHg without medications or qualified if IOP was >5 and ≤21 mmHg with or without antiglaucoma medications. Secondary outcome measures were mean and percentage IOP reduction, complications, and risk factors for the failure of trabeculectomy.

Results:

The mean (±standard deviation) age at presentation was 24.1 ± 6.8 years (range, 12–35). Mean follow-up was 67 ± 41 months (range, 12–156). At 1 year, the probability of complete success was 92% (n = 56, 95% CI: 81–96%), at 3 years it was 89% (n = 47, 95% CI: 78–95%), and at the end of 5 years, it was 80% (n = 34, 95% CI: 65–89%). The probability of qualified success was 100% (n = 60) at 1 year, 98% (n = 51, 95% CI: 87–100%) at 3 years, and 96% (n = 36, 95% CI: 84–99%) at the end of 5 years. The mean IOP reduced from 35 ± 10 to 13 ± 2.5 mmHg (P < 0.001) after trabeculectomy. There was no serious postoperative complication. Young age was the only significant risk factor associated with the failure (odds ratio = 0.89, P = 0.03).

Conclusion:

Primary trabeculectomy without MMC has good success rates in JOAG.     

非穿透与穿透小梁切除术临床效果对比研究

目的 观察非穿透小梁切除术的临床疗效。方法 对18例(26眼)青光眼行非穿透小梁切除术(NPT)，在浅层巩膜瓣下，切除层间巩膜、Sehlemm管外壁，手术不进入前房，使房水从小梁网渗出，达到降低眼压的目的。并与我院行小梁切除术(PT)，随访资料完整的19例(26眼)青光眼加以对比。术后分别观察前房反应、眼压、视力及滤过泡情况。结果 随访期间眼压≤21mmHg(1mmHg=0．133kPa)者NPT组有22眼(84．62％)，PT组有23眼(88．46％)；其中NPT组有9眼(34．62％)、PT组有8眼(34．78％)需加用抗青光眼药物。NPT组术后反应轻微，视力较稳定。PT组有不同程度术后反应及并发症。结论 NPT与PT均可有效降低眼压，因NPT术后并发症较少，可视为一种具有良好前景的抗素光眼新手术。     

无巩膜缝线小梁切除术治疗青光眼的临床研究

目的:探讨无巩膜缝线小梁切除术治疗青光眼的临床效果。方法:选取2007-12/2010-06于我院治疗的各型青光眼45例57眼,随机分为两组,观察组24例29眼采用无巩膜缝线小梁切除术(联合滤过道及结膜下注入适量HealonGV),对照组21例28眼并与同期行常规小梁切除术。观察两组术后眼压、前房、滤过泡及并发症情况。结果:术后随访3～30mo,观察组眼压控制率和功能性滤过泡形成率均高于对照组(P<0.05),并发症发生率低于对照组(P<0.05)。结论:无巩膜缝线小梁切除术(联合滤过道及结膜下注入适量Healon GV)是治疗青光眼的一种有效方法。     

小梁切除术式改进

目的　探讨提高小梁切除术远期疗效,阻止引流口瘢痕闭塞的方法。方法　对５４ 例５４ 眼青光眼采用改良小梁切除术。手术方法将原来术中丢弃的小梁巩膜作巩膜嵌顿术,将原来丢弃的周边虹膜作虹膜嵌顿术。结果　５４眼术前平均眼压为２．９３ｋＰａ,随访１７．３ｍ ｏ,平均眼压２．２６ｋＰａ,滤过泡明显且范围广３１ 眼,中等滤过泡２０ 眼,滤过口平坦３眼按摩后滤过泡重现。结论　改良小梁切除术对提高小梁切除术远期效果有益,并有一定优点。     

生物羊膜在青光眼小梁切除术中应用的临床观察

目的:探讨生物羊膜在青光眼小梁切除术中应用的疗效。方法:对16例(16眼)进行滤过性小梁切除手术,术中用生物羊膜填充在巩膜瓣下层间,进行临床观察。结果:I型、II型滤过泡13眼;Ⅲ型滤过泡3眼。在术后1mo眼压16眼均在正常范围内;术后6mo,14眼眼压≤21mmHg,有2眼需用药物控制在正常范围。结论:生物羊膜在青光眼小梁切除术中应用,提高了滤过性小梁切除手术成功率。