自体巩膜条翻转引流青光眼滤过术的实验研究

目的 证明自体巩膜条翻转引流在青光眼小梁切除术后有保持滤过道畅通的作用。方法 健康成年家兔２５只,用自体巩膜条做为引流物,在巩膜瓣下引流,同一只家兔另一只眼做经典的小梁切除,进行滤过泡、眼压及组织学观察。结果 术后第１～２周,实验组眼压低于对照组,差异无显著性（Ｐ〉０．０５）。术后第３～１２周,实验组眼压明显低于对照组（Ｐ〈０．０５）。术后第２～７周,实验组功能性滤过泡存留比率明显高于对照组（Ｐ〈     

自体巩膜条翻转引流青光眼滤过术

目的 为防止青光眼滤过术后房水引流不畅和术后浅前房。方法 我们设计并开展了自体巩膜条翻转引流术,在常规小梁切除术的巩膜瓣后,再做一板层巩膜条,翻转后植入巩膜瓣下,两侧做密闭缝合。结果 治疗７８只眼术后早期观察前房形成良好,眼压正常。随访２年,１只眼滤过泡消失,手术失败。７７只眼滤过泡保持功能滤过泡,眼压正常。结论 自体巩膜条翻转引流术对长期保持滤过功能及防止并发症有良好的效果。     

改进的青光眼白内障联合手术--垂直小梁切除人工晶状体植入术

目的 探讨巩膜隧道小切口内改良垂直小梁切除巩膜翻转联合人工晶状体植入术治疗青光眼合并白内障的治疗效果。方法 对18例24眼青光眼合并白内障采用经角巩膜隧道小切口完成垂直小梁切除深层巩膜条翻转引流联合非超声乳化白内障摘出人工晶状体植入术，术后观察视力、眼压、滤过泡及并发症情况。结果 术后随访3—18月，视力大于0．3者21眼，占87．5％，眼压控制在正常范围内(小于20．55mmHg)(1mmHg=0.133kPa)18眼，占75％。结论 该手术治疗青光眼合并白内障，具有良好的控制眼压和恢复有用视力的效果。     

超声生物显微镜法对CLASS术后滤过通道演变的观察分析

目的 应用超声生物显微镜（UBM）观察CO2激光辅助深层巩膜切除术（CLASS）后滤过通道的演变过程,评估CLASS的降眼压机制。设计 队列研究。研究对象 2016 ~2017年施行CLASS治疗的开角型青光眼患者25例（25眼）。方法 CLASS术后1、3、6、12个月对术眼手术区域进行UBM检查,并进行矫正视力、眼压、视野检查。主要指标 滤过泡形态、后弹力层-小梁网膜厚度、巩膜池前后长度和高度,巩膜池大小与眼压的相关系数。结果 术后1、12个月L型及H型滤过泡分别为19眼（76%）、6眼（24%）;11眼（44%）、14眼（56%）。术后1、12个月滤过泡高度＜1 mm者分别为4眼（16%）、17眼（68%）。术后1、12个月后弹力层-小梁网膜厚度分别为（0.104±0.026）mm、（0.100±0.019）mm。术后1、12个月巩膜池前后长度分别为（2.12±1.04）mm、（1.81±0.74）mm;巩膜池高度分别为（0.52±0.18）mm、（0.46±0.17）mm。术后12个月巩膜池前后长度、高度与眼压均呈负相关（r=-0.432,-0.523,P均＜0.05）。结论 CLASS术后滤过泡高度、巩膜池大小逐渐变小,术后3个月巩膜池趋于稳定,术后6个月滤过泡形态趋于稳定。术后12个月时CLASS房水引流途径从早期的结膜下外滤过为主已转变为以内引流为主。（眼科,2020,29： 309-314）     

改良可调整缝线在小梁切除术中的应用

目的：探讨小梁切除术中应用改良可调整缝线的方法和疗效。方法：对65例70眼原发性急性闭角型青光眼患者行小梁切除术,术中对巩膜瓣采用改良可调整缝线缝合。观察术后眼压、前房、滤过泡、可调整缝线松脱等情况。结果：所有患者随访时间6～24（平均11）mo。可拆除缝线拆线时间1～14（平均7.4）d。拆线前眼压13.30～28.46（平均16.86）mmHg,拆线后眼压8.40～16.57（平均10.50）mmHg,二者差异有统计学意义（P〈0.05）。70眼均无拆线并发症和滤过泡渗漏。术后70眼中Ⅰ度浅前房3眼,Ⅱ度浅前房2眼,浅前房发生率7%。70眼末次随访眼压9.00～16.80（平均11.45）mmHg,70眼形成扁平滤过泡55眼,微小囊样滤过泡15眼,功能性滤过泡100%。结论：改良可调整缝线在小梁切除术中安全、术后有效,可有效控制术后房水滤过水平,有利于远期眼压的控制和功能滤过泡的形成。     

Tight scleral flap trabeculectomy with postoperative laser suture lysis

Thirty eyes of 30 patients underwent tight scleral flap trabeculectomy. Of these eyes, 22 underwent laser lysis of the scleral flap sutures, whereas eight eyes did not require such treatment because of low intraocular pressure and active filtering blebs. In the 22 eyes treated, preoperative intraocular pressure was 32.6 +/- 8.3 mm Hg, whereas postoperative and pre-laser intraocular pressure was 29.3 +/- 7.4 mm Hg. Immediately after laser suture lysis, intraocular pressure dropped by 22.7 +/- 9.4 mm Hg (P less than .01) to 6.6 +/- 7.0 mm Hg, with elevation of the conjunctival bleb in all eyes treated. After a mean follow-up of 14.4 months, intraocular pressure was controlled (less than or equal to 18 mm Hg) in 20 of the 22 eyes treated (91%). The only major complication was a single case of anterior chamber flattening with intraocular lens touching the corneal endothelium. Combination of tight scleral flap trabeculectomy with subsequent postoperative laser suture lysis is a safe and effective method for low-level intraocular pressure control. This technique seems to combine the advantages of full-thickness filtration and trabeculectomy by achieving relatively low intraocular pressures while minimizing complications caused by excessive aqueous runoff.     

隧道刀制作双层巩膜瓣的青光眼小梁切除术后疗效观察

目的：：探讨隧道刀制作双层巩膜瓣并切除层间巩膜瓣的青光眼小梁切除术的临床疗效。方法：采用随机分组方法,将46例60眼青光眼患者分为治疗组24例32眼和对照组22例28眼。前者用隧道刀制作双层巩膜瓣,浅层巩膜瓣大小约为5mm×5.5mm,1/3巩膜厚度,瓣下再做一大小约3.5mm×4mm的巩膜瓣,1/3巩膜厚度,切除中间层的巩膜瓣,切除2mm×2mm小梁组织,常规行虹膜周边切除,可调节缝线缝合浅层巩膜瓣,缝合球筋膜、球结膜;后者行常规青光眼小梁切除术。结果：术后随访1a,治疗组视力明显优于对照组,两组比较差异有统计学意义(P<0.05)。两组患者术后眼压均明显低于术前眼压。术后1,3 mo时,两组患者的眼压比较差异无统计学意义(P>0.05),但术后6,12mo检查发现,治疗组患者的眼压明显低于对照组,差异有统计学意义(P<0.05)。术后1a治疗组和对照组的累积完全成功率分别为90.63％和75％,两组的累积条件成功率分别为96.88％和89.29％,两组比较差异有统计学意义(均P<0.05)。结论：隧道刀制作双层巩膜瓣并切除层间巩膜瓣的小梁切除术降眼压效果好,巩膜瓣厚薄均匀、表面光滑,滤过泡功能维持时间长,术后并发症少,适用于多种类型的青光眼,值得临床推广。     

Characteristics of filtering blebs after fornix-based trabeculectomy with a scleral tunnel

PURPOSE: To evaluate the characteristics of filtering blebs after fornix-based trabeculectomy with a scleral tunnel. PATIENTS AND METHODS: We studied 119 eyes of 149 patients who had undergone fornix-based trabeculectomy with mitomycin C as their primary surgery between 2000 and 2002 and in whom we could evaluate the characteristics of filtering blebs after a follow-up period of 6 months or more, and whose intraocular pressure at the evaluation time was 18 mmHg or less. We evaluated the width, depth, height, border, avascular area, conjunctival thickness, and late-onset bleb leak of the filtering blebs. RESULTS: The mean period of evaluation was 528 +/- 243 days (mean +/- standard deviation) after surgery, and the mean intraocular pressure at that time was 12.0 +/- 3.0 mmHg. Among these patients, 108 eyes (72.5%) had completely diffuse blebs and 90 eyes (60.4%) had completely vascular blebs. There was no apparent late-onset bleb leak. CONCLUSION: Fornix-based trabeculectomy with a scleral tunnel appears to be an effective method of developing diffuse, vascular and safe blebs with a low risk of late-onset bleb leak.     

穿透性小梁切除和滤道成形术的临床研究

目的 临床评估作者设计的穿透性小梁切除和滤道成形术的安全性和有效性。方法 在穿透性小梁切除术中,于巩膜办下植入一个T形“人工小梁支架”,借助巩膜静脉丛制成一个永存的可吸收房水的间隙。本文选用PMMA制成的人工晶状体的T形袢作支架,为8例志愿者9只绝对期或近绝对期青光眼做了这一手术。观察期5～22个月,平均15.7个月。结果 平均眼压从术前的45.6mmHg降至24.22mmHg。9眼中8眼保持了功能性或部分功能性滤遇泡;2眼视力从持续20多天无光感分别恢复到有光感和0.05。结论 本文提出的穿透性小梁切除和用PMMA制成的T形人工晶体袢作为“人工小梁支架”进行的滤道成形术安全有效,无论对开角和闭角型青光眼,降眼压效果均显著而持久,适应症比传统的非穿透性小梁切除术更广泛,应用前景光明。     

Nonpenetrating deep trabeculectomy treated with mitomycin C, without implant. A prospective evaluation of 55 cases

PURPOSE: Since 1998 we have been conducting a prospective study of nonpenetrating deep trabeculectomy with chronic open-angle glaucoma to evaluate the efficiency of the technique. MATERIAL AND METHODS: The study was carried out in 55 eyes of 41 patients who suffered from open-angle glaucoma. After performing a superior scleral flap, mitomycin diluted to 0.01% was applied for 3 minutes, then the 4 x 4-mm superficial scleral flap was dissected at two-thirds deepness until reaching the cornea. The Schlemm canal and the external trabecula were surgically removed and the two points of the Schlemm canal were catheterized with a trabeculotome to ensure that the ablation was well done. If it was not, it was completed by using a trabeculotome as a guide. Postoperatively, if the filtering bleb tended to decrease or ocular pressure began to increase, the operated trabecular region was reopened with Yag laser. The filtering bleb characteristics were correlated with the normalization of intraocular pressure in the first 30 cases. RESULTS: Preoperative pressure without treatment was 32 mmHg. Postoperative intraocular pressure without treatment was 20 mmHg or less in 79% of the eyes after 4 months, 77.5% after 6 months, 75% after 8 months and 61% after 12 months. By adding a local hypotension treatment in monotherapy, a pressure of 20 mmHg or less was obtained in 79% of the cases after 12 months. No severe complications were observed. The presence of a filtering bleb is an important factor in the normalization of postoperative pressure (p=0.0048). CONCLUSIONS: This surgical technique provides a substantial decrease in intraocular pressure and very few complications after 12 months of follow-up.     

Polyglactin sutures versus nylon sutures for scleral flap suturing in trabeculectomy

BACKGROUND AND OBJECTIVES: To note the effect on filtration function of using polyglactin sutures for scleral flap suturing in trabeculectomy. PATIENTS AND METHODS: Polyglactin sutures were compared with nylon sutures to secure the scleral flap of trabeculectomy in 30 consecutive eyes. Parameters studied were intraocular pressure, central anterior chamber depth, and bleb score in this randomized prospective study. RESULTS: Observations regarding intraocular pressure, central anterior chamber depth and bleb score in the early postoperative period were comparable in the 2 groups. The results at 12 months follow-up reveal a lower mean IOP (P < 0.05) and a higher mean bleb score (P < 0.05) in the group with polyglactin sutures. Success rate (defined as IOP < 21 mm Hg) at 12 months was 100% with use of polyglactin sutures compared to 80% with nylon sutures. CONCLUSIONS: Polyglactin sutures can be used as an alternative to nylon sutures for scleral flap suturing in trabeculectomy, with the possible additional benefit of better long-term filtration function.     

小梁切除联合巩膜瓣下羊膜植入治疗难治性青光眼

目的观察小梁切除术联合巩膜瓣下羊膜植入治疗难治性青光眼的疗效。方法对28例（35眼）难治性青光眼患者行小梁切除联合巩膜瓣下羊膜植入,观察术后滤过泡的形成、眼压变化、手术成功率和并发症的发生率。结果术后随访12～24个月。滤过泡形成情况：I型滤过泡21眼．Ⅱ型滤过泡9眼,Ⅲ型滤过泡2眼和Ⅳ型滤过泡3眼;其中,功能型滤过泡占85．7％（30／35）,非功能型滤过泡占14．3％（5／35）。眼压情况：术后第3个月,平均眼压（13．1±2．6）mmHg;术后第12个月,平均眼压（15．4±3．1）mmHg。手术总有效率为94．3％（33／35）,主要并发症为前房渗出性反应5眼,前房有少量积血1眼（为新生血管性青光眼）,均在1周内消退。结论小梁切除联合巩膜瓣下羊膜植入术能有效提高难治性青光眼的手术成功率。     

完全可拆除调节缝线在小梁切除术中临床应用

目的 探讨完全可拆除巩膜瓣调节缝线在小梁切除术中的临床应用效果.方法 对拟行小梁切除术的青光眼63例（80眼）随机分为两组：观察组（A组）29例（40眼）行完全可拆除巩膜瓣调节缝线的小梁切除术;对照组（B组）34例（40眼）行常规小梁切除术.术后观察前房情况、滤过泡形态、眼压、视力及并发症.随访3～6个月.结果 A组：未拆除调节缝线前无浅前房发生,拆除后发生浅前房7眼（17.5％）,B组浅前房9眼（22.5％）,两组差异无统计学意义（χ2 =2.83,P＞20.05）.功能性滤过泡形成：A组33眼（82.5％）,B组28眼（70.0％）,差异具有统计学意义（χ2=7.65,P＜0.05）.眼压：术后3个月、6个月,A组眼压控制较好,两组眼压下降比较差异具有统计学意义（t=2.536,2.489,P＜0.05）.术后视力：早期A组视力恢复较好,组间差异具有统计学意义（x2=8.94,P＜0.05）.术后两组主要并发症为脉络膜脱离,B组3眼（7.5％）发生角膜缘切口漏.结论 完全可拆除巩膜瓣调节缝线应用于小梁切除术,降低了术后早期并发症,提高了中远期手术疗效.     

生物膜在小梁切除术中防止滤过泡粘连的实验研究

目的 研究生物膜在实验性小梁切除术中防止滤过道粘连的作用。方法 将生物膜植入家兔小梁切除术的巩膜瓣及结膜瓣下，同一只家兔的另一只眼术中未植入生物膜作为对照眼，进行滤过泡，眼压及组织学观察。结果 （１）创伤后的修复过程于术后２～３周达到高峰，而生物膜要术后６周以后开始吸收，生物膜与瘢痕组织间不发生紧密粘连，从而保持滤过道通畅，（２）术后２～７周实验组功能性滤过存留比率明显高于对照组（Ｐ〈０．０５），     

青光眼巩膜瓣下蓄水池样小梁切除术的临床研究

目的评价巩膜瓣下蓄水池样小梁切除术治疗青光眼的效果。方法回顾54例（64眼）青光眼的治疗情况。观察组26例（32眼）采用巩膜瓣下蓄水池样小梁切除术;对照组28例（32眼）采用传统小梁切除术。术后随访6个月,观察比较两组术后眼压、滤过泡及并发症情况。结果术后6个月观察组平均眼压为（16.2±4.2）mmHg,对照组平均眼压为（19.8±6.2）mmHg,（P〈0.01）,观察组功能性滤过泡形成率明显高于对照组（P〈0.01）,并发症发生率低于对照组（P〈0.05）。结论巩膜瓣下蓄水池样小梁切除术降压效果、安全性均优于传统小梁切除术,并发症少,是一种较好的抗青光眼手术方式。     

Analysis of bleb morphology after trabeculectomy with Visante anterior segment optical coherence tomography

BACKGROUND: To describe the use of anterior segment optical coherence tomography (OCT) in imaging intrableb morphology after trabeculectomy. METHODS: 14 post-trabeculectomy eyes from 11 primary open angle glaucoma and 3 primary angle closure glaucoma subjects were studied. The blebs were classified with reference to slit lamp morphology and bleb function. They included diffuse filtering (n = 7), cystic (n = 2), encapsulated (n = 2) and flattened (n = 3) bleb types. One eye in each patient was imaged with the Visante anterior segment OCT. A vertical scan line of 10 mm consisting of 512 A-scans was positioned at the centre of the bleb. The images were then analysed by built-in software. Intrableb morphologies and structures, including bleb wall thickness, subconjunctival fluid collections, suprascleral fluid space, scleral flap thickness, intrableb intensity (low, medium or high) and the route under the scleral flap were characterised and measured. RESULTS: Diffuse filtering blebs were found by subconjunctival fluid collections. Suprascleral fluid space and the route under the scleral flap were identified in four of the seven cases. Cystic blebs were composed of a large hyporeflective space with multiloculated fluid collections covered by a thin layer of conjunctiva. Encapsulated blebs had a thick bleb wall with high reflectivity and an enclosed fluid filled space. Flattened blebs demonstrated high scleral reflectivity and no bleb elevation. CONCLUSIONS: Visante anterior segment OCT can be used for bleb imaging. The different patterns of intrableb morphology identified by OCT were related to slit lamp appearance and bleb function. This information may be useful to study the different surgical outcomes and the process of wound healing in trabeculectomised eyes.     

改良复合式青光眼小梁切除术临床观察

目的:评价表面麻醉下改良巩膜瓣联合应用丝裂霉素C和可调整缝线在青光眼小梁切除术中的效果。方法:首次接受小梁切除术的病例58例(70眼),术中丝裂霉素C的浓度为0.2～0.3g/L,时间为2～4min;巩膜瓣两侧作两条可调整缝线。临床观察指标包括术后眼压、滤过泡和并发症。结果:所有病例平均随访12.5±3.5mo,术后各时期的眼压与术前眼压比较均明显下降;术后1a,功能性滤过泡形成率为87.1%;无低眼压性黄斑病变等严重并发症出现。结论:青光眼小梁切除术中表面麻醉下改良巩膜瓣联合丝裂霉素C、可调整缝线可以有效地降低麻醉并发症,缩短手术时间,降低患者的眼内压,减少术后并发症。     

巩膜瓣可拆缝线及角膜侧切口在小梁切除术中的应用

目的观察巩膜瓣可拆缝线及角膜侧切口对小梁切除术后低眼压、浅前房的影响。方法青光眼95例(145眼)在常规小梁切除术中联合应用巩膜瓣可拆缝线及角膜侧切口,术中全部病例人工形成前房,观察术后前房形成情况、滤过泡形态及眼压水平,根据眼压高低、滤过泡形态及前房深浅决定拆除可拆缝线时间,并将浅前房发生率与行单纯小梁切除术的144例(179眼)作对比。结果小梁切除联合巩膜瓣可拆缝线及角膜侧切口术后12眼发生浅前房,浅前房发生率为8.2％;单纯小梁切除术后,浅前房发生率为18.4％。二者相比有显著差异(P<0.01)。结论小梁切除联合巩膜瓣可拆缝线及角膜侧切口可主动调节房水滤过量,促进功能性滤过泡形成,减少小梁切除术后低压性浅前房的发生。     

正常羊眼小梁切除联合滤道成形术的研究

目的探讨用甲基丙烯酸甲酯（PMMA）材料制成的巩膜瓣支架植入巩膜瓣下的滤道成形术效果。方法选择正常小尾寒羊32只,采用随机数字表法分为实验组或对照组。实验组行巩膜瓣下支架植入术,对照组行单纯小梁切除术。术前和术后连续1年观察其眼压和眼前节变化、超声活体显微镜（UBM）、光镜、电镜检测情况。结果实验组眼压下降幅度明显大于对照组,术后4周对照组眼压基本恢复至原水平,实验组至少延期至术后3个月回复至原眼压水平。UBM检测滤过泡形态：术后1周、1个月,实验组可见植入支架的强回声和大“液间腔”;术后3个月,滤过泡仍较膨松;术后4周,对照组滤过泡低平,滤过道即已闭塞。组织病理学检查结果：术后4周,对照组滤过道已纤维化;实验组术后滤过道延期愈合,3个月时,支架与周围组织仍有间隙;6个月时,此间隙消失,支架与周围组织全部愈合,显示组织相容性好,无排斥现象。病理检查结果与UBM检测结果完全一致。术后1年,实验组未见明显毒、副作用。结论采用PMMA材料制成的巩膜瓣支架植入巩膜瓣下的滤道成形术效果安全、有效,较传统小梁切除术的降眼压效果显著而持久。     

Clinical results of fornix-based trabeculectomy with a scleral tunnel

PURPOSE: To evaluate retrospectivery the efficacy and safety of fornix-based trabeculectomy with a scleral tunnel. PATIENTS AND METHODS: We studied the records of 204 eyes of 156 patients who underwent fornix-based trabeculectomy with mitomycin C as their primary surgery between 2000 and 2002 and had a follow-up period of 6 months or more. A 3.5 or 4 mm rectangular double scleral flap incision was made and a scleral tunnel was fashioned by removing the second flap to allow the aqueous to flow into the fornix side. RESULTS: The mean intraocular pressure was significantly decreased from 22.2 +/- 7.8 (mean +/- standard deviation) mmHg to 12.4 +/- 3.9 mmHg 2 years after surgery (p < 0.0001). When the target pressure was defined as 15 mmHg, the 2-year survival rate using the Kaplan-Meier survival analysis was 69.1 %. Early wound leakages occurred in 16 eyes (7.8%) and additional sutures were needed on 13 eyes. The visual acuity of 22 eyes (11.0%) decreased by at least 2 lines. CONCLUSION: Although there are some complications specific to trabeculectomy, fornix-based trabeculectomy with a scleral tunnel appears to be an effective method of decreasing intraocular pressure.