小梁切除联合周边虹膜嵌顿术的临床分析

目的为了提高青光眼手术的成功率，将小梁切除术加以改进，即小梁切除联合周边虹膜嵌顿术（ＴＩ二联术）。方法８７例１０３只眼行ＴＩ二联术，对照组小梁切除术１６３例１６８只眼，观察比较术后眼压、视力。结果闭角型青光眼ＴＩ二联术手术成功率为９６．５５％，小梁切除术成功率８５．２７％，有显著差异。对于开角型青光眼，两种手术方法的成功率均为７５％～７６％。结论原发性闭角型青光眼ＴＩ二联术手术成功率明显高于小梁切除术，但对于原发性开角型青光眼，两种术式成功率相似。     

急性闭角型青光眼小梁切除术后角膜内皮形态研究

为探讨急性原发性闭角型青光眼（ＰＡＣＧ）及其小梁切除术后角膜内皮细胞（ＣＥＣ）的形态计量学变化和临床意义。对３６例ＰＡＣＧ患者于小梁切除术前和术后３个月进行了角膜内皮细胞观察和图象分析。结果：与正常人相比，ＰＡＣＧ患者ＣＥＣ密度、形状系数明显减小，面积、周长、长径、变异系数增大（Ｐ＜０．０１）。无并发症的小梁切除术未使ＣＥＣ发生形态计量学变化。而术后浅前房者与术前相比ＣＥＣ密度和形状系数进一步减小。面积、周长、长径和变异系数进一步增大。结论：ＰＡＣＧ患者ＣＥＣ处于不稳定状态，应尽早控制眼压，在选择小梁切除术时防治术后浅前房对保护ＣＥＣ十分重要     

复合式与常规小梁切除术后浅前房的临床对比

目的 比较复合式小梁切除术及常规小梁切除术术后浅前房的发生情况.方法 青光眼124例(148眼)分为2组.复合式手术组(A组)62例(76眼)行复合式小梁切除术,即增加可拆除的调节缝线及术中应用丝裂霉素C及黏弹剂;对照组(B组)62例(72眼)行常规小梁切除术;观察两组术后前房形成的情况,并作统计学分析.结果 A组术后浅前房发生率为17.1﹪(13眼),B组为40.3﹪(29眼),两者差异有统计学意义(χ2=4,P=0.002).结论 复合式小梁切除术较传统的小梁切除术能较迅速恢复和维持术后前房深度,有效减少术后浅前房发生,提高手术成功率.     

复合式和常规小梁切除术后浅前房的临床观察

目的观察复合式小梁切除术及常规小梁切除术术后浅前房的发生情况。方法青光眼120例142眼随机分为两组。复合式手术组（A组）60例74眼行复合式小梁切除术即增加可拆除的调节缝线及术中应用5-FU；对照组（B组）60例68眼行常规小梁切除术，观察两组术后前房形成和眼压情况并作统计学分析。结果术后浅前房发生率A组为6．76％（5眼），B组为35．29％（24眼）。二者差异具统计学意义（P〈0．05）。发生原因以滤过过强、脉络膜脱离为多见。结论复合式小梁切除术能迅速恢复和维持术后前房深度，有效减少术后浅前房发生，提高手术成功率。     

复合式与常规小梁切除术后浅前房的对比分析

目的:对比分析复合式与常规小梁切除术后浅前房的发生情况。方法:青光眼56例(71眼)分为2组。复合式手术组(A组)29例(36眼)行复合式小梁切除术;对照组(B组)27例(35眼)行常规小梁切除术。观察两组术后浅前房的发生情况,并作统计学分析。结果:A组术后浅前房发生率为14%(5眼),B组为37%(13眼),两者差异有统计学意义(χ2=5.07,P<0.05)。结论:复合式小梁切除术较传统的小梁切除术能较迅速恢复和维持术后前房深度,有效减少术后浅前房发生,提高手术成功率。     

青光眼小梁切除术后浅前房的原因及处理

目的:分析青光眼小梁切除术后浅前房的发生原因和处理方法。方法:对1556例1556眼施行小梁切除术的青光眼病例术后浅前房的原因进行分析,总结治疗方案。结果:术后发生浅前房148眼(9.51%)。滤过过强,结膜瓣渗漏,睫状体脉络膜脱离,睫状环阻滞性青光眼是术后浅前房发生的主要原因。术后相应处理后,147眼浅前房均恢复正常,1眼未恢复最终施行眼球摘除术。结论:青光眼小梁切除术术前、术后有效地控制眼压,术中保持前房深度,小梁切除大小适宜,巩膜瓣厚度均匀勿太薄,注意伤口缝线的松紧,术后观察眼压及前房的变化,及时对症处理并发症能取得较好效果。     

改良小梁切除术治疗青光眼的临床观察

目的观察改良小梁切除术治疗青光眼的临床疗效。方法随机选择29例（35眼）青光眼施行改良小梁切除术作为观察组;随机对照组31例（37眼）行单纯小梁切除术,分析比较两组术后眼压、滤过泡和前房深度。结果改良小梁切除术（观察组）术后浅前房发生率较对照组低,术后半年观察组的功能性滤过泡较对照组多。结论改良小梁切除术不仅能提高滤过性手术的成功率而且能减少术后并发症的发生。     

巩膜瓣可调缝线在小梁切除术中的应用

目的 小梁切除术的长期效果主要是依赖滤过作用,术后大多数并发症是由于浅前房所致。现研究能使小梁切除术保持长期效果的缝合方法。方法 小梁切除术巩膜瓣暂时可调缝线用于２５例患者。分析了术后情况,观察了术后前房深度和滤过泡情况。结果 巩膜瓣可调缝线可减少术后浅前房的发生,滤过 形成良好,结论 小梁切除术巩膜瓣可调整缝线有明显的优点。     

消毒空气泡在青光眼小梁切除术中的应用

目的:探讨空气泡在青光眼小梁切除术中的应用效果。方法:对30眼青光眼小梁切除术患者术中前房注入消毒空气泡维持前房、术毕前利用消毒空气泡形成前房,观察术中前房深度、前房出血影响情况、术后浅前房的发生率,并与对照组相比较。结果:所有患者均能在前房不完全消失的情况下完成手术,前房出血不累及瞳孔区,术后浅前房发生率较低。结论:在青光眼小梁切除术中使用消毒空气泡的方法简便易行,降低了术中术后并发症的发生和危害,有效地提高了手术的安全性和成功率。     

前房穿刺在小梁切除手术中应用的临床观察

目的探讨完善小梁切除术,减少术中、术后并发症的途径。方法在抗青光眼小梁切除术中应用前房穿刺术,观察手术效果。结果术后3眼发生浅前房、发生率为4.5%,经治疗前房深度恢复正常。术后随访3～12月,眼压控制在10～17mmHg(1mmHg=0.133kpa)。结论前房穿刺术在小梁切除手术中应用,能有效地控制术后低眼压性浅前房的发生,并有助于手术操作,提高手术成功率。     

小梁切除加巩膜瓣可拆除缝线术临床应用研究

目的 探讨巩膜瓣外置可拆除缝线在青光眼小梁切除术中的临床应用效果.方法 对已确诊的开角及闭角型青光眼126例,随机分为两组.实验组61例(120只眼),即小梁切除及虹膜周边切除.巩膜瓣两角缝合后,再行巩膜瓣两侧外置可拆除缝线,水密缝合.对照组为常规小梁切除术65例(113只眼),术后随访6-12个月.结果 术后1周两组眼压与术前相比差异有统计学意义,而两组问比较差异无统计学意义(t=1.85,P=0.08);术后6个月实验组平均眼压(14.34±3.95)mmHg,对照组(19.57±7.76)mmHg,差异有统计学意义(P相似文献   

可调节缝线在小梁切除术中的应用

目的探讨青光眼小梁切除术中应用可调节缝线的效果。方法回顾分析对照组73例（83眼）常规小梁切除术和观察组112例（127眼）常规小梁切除术的基础上加可调节缝线,比较在术后1周内浅前房的发生率,眼压的控制及两组中部分术后随访1a的眼压控制及功能性滤过泡的维持情况。结果术后1周浅前房的发生率对照组为19．28％,观察组为9．45％,两组统计学上差异有统计学意义（χ^2=5．28,P〈0．05）。术后1周眼压控制率对照组86．75％,观察组85．82％,两组差异无统计学意义（χ^2=0．43,P〉0．05）,术后1a眼压的控制率对照组为72．22％,观察组为89．29％,（χ^2=6．83,P〈0．01）。功能性滤过泡的比率对照组79．63％,观察组为92．67％（χ^2=4．30,P〈0．05）。结论小梁切除术中应用可调节缝线较常规小梁切除术能更好地维持术后正常的前房,且远期控制眼压及维持功能性滤过泡效果良好。     

Safety and efficacy of combined trabeculectomy for primary angle closure glaucoma with persistent ocular hypertension

Purpose:To investigate the safety and efficacy of combined trabeculectomy for primary acute angle closure glaucoma with persistent ocular hypertension.Methods:A total of 36 patients (40 eyes) with primary acute angle closure glaucoma,who were treated with combined trabeculectomy in the Ophthalmology Unit of our hospital,were selected.Before the procedure,patients were assigned to ocular hypertension group( ≥ 40 mm Hg) or control group(＜ 40 mm Hg) based on intraocular pressure.These two groups were followed up for one year,and compared for post-operative visual acuity,intraocular pressure, filtering bleb,anterior chamber depth, and the occurrence of complications.Results:At 1 week,6 months,and 12 months after the procedure,intraocular pressure was controlled in both the ocular hypertension group and the control group,without significant differences between the two groups (P＞0.05).At 1 week,6 months,and 12 months after the procedure,all of the patients,in both groups,had improved in terms of visual acuity,with a significant difference before and after the procedure for the ocular hypertension group (P＜0.05).After follow-up at 12 months,the two groups presented no statistically significant differences in anterior chamber depth,filtering bleb survival,or the incidence of post-operative complications (P＞0.05 for all).Conclusion:It is feasible,safe,and effective to perform combined trabeculectomy on patients with primary acute angle closure glaucoma complicated by persistent ocular hypertension.     

高眼压下原发性急性闭角型青光眼手术治疗的效果

目的:探讨原发性急性闭角型青光眼持续高眼压下行复合式小梁切除术的效果.方法:选取2015-02/2016-02在我院治疗的原发性急性闭角型青光眼患者62例62眼,其中对照组34例34眼(术前眼压控制在正常范围,眼压<21mmHg),观察组28例28眼(术前眼压28~50mmHg;高眼压持续3d以上).两组均行复合式小梁切除术,观察两组患者手术前后视力、眼压等变化.结果:观察组术后3 mo视力较术前提高、不变和下降的比例分别为68%、21%和11%,与对照组比较差异无统计学意义(P>0.05);两组术后眼压均较术前明显减小,差异有统计学意义(P<0.05);观察组和对照组术后眼压分别为11.10±2.20、11.73±2.71mmHg,差异比较无统计学意义(P>0.05);观察组术前及术后前房深度均低于对照组,差异有统计学意义(P<0.05);两组术后前房深度均较术前有所增加,差异有统计学意义(P<0.05);两组术后眼轴长度均较术前有所减少,差异有统计学意义(P<0.05);观察组术后并发症发生率为14%,对照组并发症发生率为18%,差异比较无统计学意义(P>0.05).结论:高眼压下原发性急性闭角型青光眼行复合式小梁切除术是有效的,但仍需进一步研究.     

小切口小梁切除术治疗闭角型青光眼

目的　探讨小切口小梁切除术治疗闭角型青光眼的疗效。方法　回顾 2 0 0 2年 4月～ 2 0 0 2年 9月在我院接受滤过性手术的闭角型青光眼 5 0例 ( 64眼 )。随机分为 2组 :观察组 2 7例 ( 3 5眼 ) ,采用小切口小梁切除术 ;对照组 2 3例 ( 2 9眼 ) ,采用复合式小梁切除术。分析两组术后 6月内的眼压及并发症的发生率等。结果　两组术后第 1周内眼压差异有显著性意义 ,观察组眼压高于对照组 (P <0 0 5 ) ,尔后差异无显著性意义。两组术后早期滤过泡渗漏和前房积血的发生率差异无显著性意义 ;浅前房、脉络膜脱离的发生率 ,住院时间等差异有显著性意义 (P <0 0 5 ) ,观察组低于对照组。结论　小切口小梁切除术手术方法简单 ,术后并发症少 ,术后恢复快 ,且可以达到与复合式小梁切除术同样的降眼压效果     

A comparative study of small incision trabeculectomy avoiding Tenon's capsule vis-à-vis trabeculectomy with Mitomycin-C

PURPOSE: To compare the results of small incision trabeculectomy avoiding Tenon's capsule (SIT) vis-à-vis intraoperative use of Mitomycin-C (MMC) in primary chronic angle closure glaucoma. METHODS: A controlled prospective study was conducted on 60 consecutive primary chronic angle closure glaucoma patients requiring glaucoma filtration surgery. Patients were divided into two groups, Group I (n = 30): those undergoing SIT and Group II (n = 30): those undergoing trabeculectomy with MMC. Patients were followed up serially for 24 months and their intraocular pressure (IOP) was monitored. Success was defined as IOP < or = 22 mm Hg with no additional anti-glaucoma medication or laser/surgical intervention. Success was also defined as a 30% reduction from the initial IOP at which optic disc cupping and/or visual field changes occurred. RESULTS: The final mean IOP with SIT was 16.80 +/- 4.20 mm Hg as against 17.84 +/- 3.80 mm Hg with trabeculectomy with MMC. Final success rate of 93.3% was obtained with SIT versus 90% with trabeculectomy with MMC. No major complications were seen with either procedure. CONCLUSION: Small incision trabeculectomy safely and effectively reduces the IOP in over 90% cases. The advantages of this procedure over trabeculectomy with MMC are its low cost, use of a small (2.5 mm) limbal incision which obviates the dissection of Tenon's capsule and absence of any major complication.     

复合式小梁切除术治疗急性闭角型青光眼临床观察

目的探索复合式小梁切除术对急性闭角型青光眼患者眼压及术后并发症的影响。方法选取2015年6月至2018年3月本院收治的急性闭角型青光眼患者82例,以随机数字表法分为两组,均41例。对照组实施传统小梁切除术治疗,观察组则行复合式小梁切除术。比较两组患者术前及术后1个月、3个月时眼压与黄斑水肿、低眼压、浅前房、前房出血等术后并发症发生情况。结果观察组术后1个月、3个月时眼压分别为(14.22±2.16)mmHg、(16.53±2.16)mmHg,并发症发生率为7.32%;对照组术后1个月、3个月时眼压分别为(17.89±2.65)mmHg、(19.85±2.35)mmHg,并发症发生率为24.39%。与对照组比,观察组术后1个月、3个月时眼压均较低,并发症总发生率较低,差异有统计学意义(t/x^2=6.879、7.132、8.997;P=0.001、0.001、0.000)。结论对急性闭角型青光眼患者运用复合式小梁切除术可有效将患者眼压控制在正常水平,且并发症较少。     

复合式小梁切除加前房注射过滤空气治疗原发性慢性闭角型青光眼

目的：观察复合式小梁切除加前房注射过滤空气治疗原发性慢性闭角型青光眼的临床疗效及手术的安全性和有效性。

方法：将2015-09/2017-06在我院收治的原发性慢性闭角型青光眼患者129例183眼分为注气组和对照组,注气组(68例97眼)行复合式小梁切除加前房注射过滤空气,对照组(61例86眼)行复合式小梁切除术,随访时间3～6(平均4.5)mo,观察术后视力变化、眼压、滤过泡形成、并发症情况,同时记录非计划再次手术情况、住院天数及住院总费用。

结果：注气组术后浅前房、恶性青光眼、非计划再次手术发生率低于对照组,注气组住院天数少于对照组,注气组住院总院费用低于对照组(均P<0.05)。两组不同时间眼压比较,差异有统计学意义(F_组别=42.394,P_组别<0.001; F_时间=7.373,P_时间<0.001; F_交互=23.903,P_交互<0.001)。注气组术后1、3d眼压均高于对照组(P<0.001),术后7d,3mo两组眼压均无差异(P>0.05)。术后1、3、7d,1mo两组前房闪辉情况均无差异(P>0.05),术后3mo两组视力变化、滤过泡形成均无差异(P>0.05)。

结论：复合式小梁切除加前房注射过滤空气治疗原发性慢性闭角型青光眼可降低术后浅前房、恶性青光眼及非计划再次手术的发生率,不会加重前房炎症反应,可以安全地保留患者的剩余视功能,同时还可以缩短住院天数及住院总费用,对眼压、视力、滤过泡形成无明显影响。     

The Clinical Outcomes of Three Surgical Managements on Primary Angle-closure Glaucoma

Purpose: To investigate the efficacy of trabeculectomy, phacotrabeculectomy and phaco-emulsification in the management of primary angle closure glaucoma (PACG). Methods: A prospective observational study was performed in 88 chronic PACG patients (97 eyes) who were divided into three groups following defined indications to receive different surgical interventions. The indications and clinical outcomes were evaluated. The mean follow-up was (17.7±4.9) months. Results: Success rate in trabeculectomy, phacotrabeculectomy and phacoemulsification group was 81.08%, 78.57‰ and 81.25‰, respectively. The anterior chamber depth was deeper and the angle was wider postoperatively vs. preoperatively both in phaco-trabeculectomy and phacoemulsification group. No obvious changes were seen in trabeculectomy group. The coefficient of outflow facility of aqueous humor (C values) significantly increased in three groups postoperatively (P < 0.01). No severe intra-operative complications were found and the incidence of postoperative complications was low. Five eyes sustained hypotony 3±1.87 months in trabeculectomy group and 1 eye happened malignant glaucoma in phacotrabeculectomy group. The visual acuity in patients with phacotrabeculectomy plus intraocular lens implantation and those only with phacoemulsification plus intraocular lens implantation were improved 78.57% and 93.74%, respectively. No significant improvement was found in trabeculectomy group (χ2 = 47.10, P < 0.001). Conclusion: Three surgical interventions were beneficial to manage PACG and with co-existing cataract. The indication choosing was suggested according to visual acuity, angle closure circumference, cataract, medication requirements and optic nerve damage. Phacotrabeculectomy was recommended for angle closed ≥180° circumference while phacoemulsification for angle closed < 180°.     

Further experience with trabeculectomy.

Trabeculectomies performed on 33 eyes were compared to 28 standard filtering procedures done at the same institution during a 4 year period. The success rates in the two groups of patients whether white or black were statistically comparable, 92% in the trabeculectomy group and 77% in the standard filtering surgical group. Only cases of phakic open angle glaucoma, chronic angle closure and combined mechanism glaucoma were considered. Cases of secondary glaucoma, previous surgical failure and aphakic nonpupillary block glaucoma did uniformly poorly. When trabeculectomy was performed with "enhanced cyclodialysis" early results in a few cases were successful. The incidence of flat anterior chamber and cataracts with permanent reduction in visual acuity was significantly less in the trabeculectomy group than in the standard filtering procedure group. These results support previous studies which support trabeculectomy as successful as standard filtering procedures with the advantage of having fewer permanent serious complications.