非穿透性小梁手术联合透明质酸生物胶植入术的疗效

目的 研究非穿透性小梁手术联合透明质酸生物胶植入术治疗开角型青光眼的手术效果及有效的降压机制。方法 将临床接治的19例(28只眼)开角型青光眼行非穿透性小梁手术联合透明质酸生物胶植入术,术后观察眼压、结膜滤枕及前房反应等情况,随访6～24个月。结果 28只眼术前平均眼压(23.92±1.26)mmHg,下降幅度36.33％,差异有显著性(P＜0.01),24只眼结膜形成功能性滤过泡,4只眼功能性滤过泡消失。28只眼均无前房出血,术后前房反应轻。结论 非穿透性小梁手术联合透明质酸生物胶植入术能有效地降低开角型青光眼的眼压,术后并发症少,可做为此类青光眼病人手术的选择。     

非穿透性小梁手术联合透明质酸钠生物胶植入术的临床观察

目的 :观察非穿透性小梁手术 (nonperforatingtrabecularsurgery ,NPTS)联合透明质酸钠生物胶植入术的临床疗效。方法 :对 7例 11眼开角型青光眼行NPTS联合透明质酸钠生物胶植入术。术后对视力、眼压、滤过泡、前房、房角、并发症等进行观察 ,并作超声生物显微镜 (UBM )检查。结果 :经 2～ 15个月 ,平均 (10 3 6± 9 2 0 )个月的随访 ,9眼视力无变化 ,2眼有波动 (原有视网膜出血复发 ,经治疗后恢复 )术前平均眼压 (2 8 5 5± 12 0 9)mmHg (1mmHg =0 13 3kPa) ,术后 (13± 5 68)mmHg ,平均降低 15 5 5mmHg ,降低率为5 4 47% ,手术前后有高度显著性差异 (P <0 0 1) ,11眼眼压均 <2 1mmHg ,其中 2眼局部点用一种抗青光眼药物 ,占 18 18% ,未用药 9眼 ,占 81 82 %。术中小梁网 -狄氏膜窗微穿孔 3眼 (未作处理 ) ,前房少量出血 1眼 ,2天后吸收 ,前房轻度变浅 3眼 ,分别于术后 2～ 5天恢复。术后房水轻度闪辉 3眼 ,均 2～ 5天内消失。滤过泡 :Ⅰ型 (微囊型 ) 2眼 ,Ⅱ型 (弥漫型 ) 7眼 ,Ⅳ型 (包囊型 ) 2眼。房角可见相应手术区房角 -长方形变薄半透明区域 ,并隐约可见巩膜瓣下的液腔 ,微穿孔的 3眼 ,微穿孔区不明显 ,无虹膜前粘连。术后 2周后行UBM检查 ,可见手术区域房角开放 ,所剩小梁厚 0 0 75mm～     

非穿透性小梁手术联合SKGEL胶植入术42例临床分析

目的观察非穿透性小梁手术联合SKGEL胶植入术治疗青光眼的临床疗效。方法对42例(64眼)青光眼患者施行非穿透性小梁手术联合SKGEL胶植入术。术后观察眼压、视力、滤过泡形态、并发症等,并做超声生物显微镜(UBM)观察。结果经3～18mo的随访,末次随访视力62眼(97%)维持不变或提高。眼压由术前平均(29.68±13.55)mmHg降至术后末次随访平均眼压(13.68±5.13)mmHg,有非常显著性差异(P<0.01),64眼术后均形成滤过泡,其中60眼为功能性。术中微穿孔5眼,虹膜嵌顿术口1眼,术后前房少量出血2眼,前房轻度变浅8眼,房水轻度闪辉3眼,后弹力层脱落1眼。术后2wkUBM检查见睫状体脱离37眼。结论非穿透性小梁手术联合SKGEL胶植入术能有效降低眼压,术后视力稳定,并发症少,值得临床应用推广。     

非穿透小梁手术中穿透前房的原因及处理

目的 :探讨非穿透小梁手术中发生穿透前房的原因及处理。方法 :分析开展的非穿透小梁手术 6 9只眼中 ,发生术中穿透前房的 13例 (14只眼 )的情况及其处理 ,对这 13例患者进行 3～ 12个月的随访 ,行眼压、视力、裂隙灯、眼底镜等检查。结果 :非穿透小梁手术中穿透前房的情况有 :制作深层巩膜瓣时切透或剪穿角巩膜、提巩膜瓣时小梁 后弹力膜裂开、撕开Schlemm管内壁等。微小穿透不处理或行周边虹膜切除 ,穿透范围大 ,改行小梁切除术。平均眼压 ,术前 (2 9 0 4± 8 4 1)mmHg(1mmHg =0 133kPa) ,术后一天 (6 13± 2 92 )mmHg ,经 3～ 12个月随访 ,最后随访眼压 (12 19± 3 2 1)mmHg ,手术前后差异有非常显著性 (t=7 0 0 ,P <0 0 0 1)。结论 :非穿透小梁手术中穿透前房与手术技巧不熟练和手术区解剖不熟悉有关 ,经针对性处理 ,仍可获得良好的效果     

羊膜植入技术在青光眼手术中的应用

目的 :观察小梁切除联合羊膜植入术及非穿透深层巩膜切除联合羊膜植入术治疗青光眼的临床疗效。方法 :对 40例闭角型青光眼 5 5只眼和 3 3例开角型青光眼 44只眼两组病例分别进行常规小梁切除术及非穿透深层巩膜切除术 ,并在巩膜瓣下植入保存羊膜。观察术后眼压、视野、视力、超生生物显微镜 (UBM )等情况。进行术前术后对比 ,并随访 12～2 8月 ,平均随访 2 0月 ,观察术后疗效。结果 :两组病例术后与术前眼压对比 ,均有降低 ,有显著性差异 ,P <0 0 1。视野及视力保持不变或改善 ,UBM检查可见羊膜形态。随访期间眼压、视野及视力维持良好 ,手术有效率分别为 98 18%和 95 45 %。未出现不良反应。结论 :小梁切除联合羊膜植入术及非穿透深层巩膜切除联合羊膜植入术可较好的防止术后组织瘢痕形成 ,是安全、经济、有效地治疗青光眼的新方法。     

非穿透性小梁手术治疗原发性开角型青光眼的临床观察

目的探讨非穿透性小梁手术（NPTS）联合透明质酸钠生物胶植入的临床疗效。方法对32例（38眼）原发性开角型青光眼实施非穿透性小梁手术联合透明质酸钠生物胶植入术。观察术后视力、眼压、滤过泡、前房反应、前房深浅及并发症。术后随访（14．6±2．3）月。结果术前平均眼压（29．2±8．01）mmHg。术后1周平均眼压（15．01±4．65）mmHg,手术前后眼压差异有统计学意义。术后30眼前房无任何反应,2眼有I度浅前房伴少许前房积血,均术后2～3d自行恢复,6眼轻度房水闪光,术后2～3d消失。所有患眼术后均形成显著弥散滤过泡。术后1周及6月视力基本稳定。结论非穿透性小梁手术联合透明质酸钠生物胶植入治疗开角型青光眼疗效肯定,并发症少,为开角型青光眼提供了一种更安全的治疗方法。     

超声生物显微镜在非穿透小梁手术后随访的意义

目的观察非穿透性小梁手术联合MMC及羊膜植入治疗开角型青光眼的远期临床效果,研究超声生物显微镜(UBM)在非穿透小梁切除术后随访的意义。方法对21例(30眼)开角型青光眼进行非穿透小梁手术联合MMC及羊膜植入术治疗,术后观察视力、眼压及滤过泡情况。分别在术后1,3,6,9,12,18月,利用UBM观察滤过泡的形态、巩膜瓣下形成液间腔的大小、剩余小梁膜的厚度及羊膜的变化。结果患者术后眼压控制良好,手术前后眼压相比,差异有统计学意义(P<0.01)。UBM下所有病例均形成前部的透明液间腔。随访期间巩膜池前部体积无明显变化,平均宽(1.936±0.516)mm,高(0.285±0.117)mm;薄层小梁网组织平均厚度为(0.128±0.057)mm,且随访期间厚度基本无改变。羊膜在术后9月左右融解后后部巩膜池无明显透明液间腔存在。结论非穿透性小梁手术联合MMC及羊膜植入能有效地降低眼压,远期效果良好。UBM适合于非穿透性小梁切除术的长期随访。     

单纯性非穿透小梁手术的临床观察

本文对10例13眼开角青光眼患者行单纯性非穿透小梁手术联合术中应用丝裂霉素C,术后观察眼压、眼内反应、滤过泡情况,并对4例5眼分别于术后22、44、86及96天行手术区超声生物显微镜检查.随访时间最短35天,最长180天.结果眼压术前13眼平均眼压36.2士13.3mmHg,13眼术后1周平均眼压为8.5士3.7mmHg,1个月眼压15.7士5.7mmHg,9眼术后2个月眼压16.3士5.6mmHg,7眼术后3个月眼压15.0±4.0mmHg,3眼术后4个月眼压13.0土4.4mmHg,4眼术后5个月眼压18.5土3.3mmHg,均较术前明显下降.UBM检查可见结膜组织疏松,减压腔存在,巩膜至脉络膜通道疏松.术中及术后均未出现浅前房、前房出血、玻璃体脱出、脉络膜脱离等并发症.结论单纯性非穿透小梁手术能安全、有效地降低眼压,是一种对开角型青光眼很有应用前景的抗青光眼手术.     

非穿透小梁手术后滤过道变化及对眼压影响的临床观察

目的 利用UBM观察非穿透小梁术后不同时期滤过道组织变化，探讨其房水引流机制，及手术失败原因。方法 对86例连续病例117眼非穿透小梁手术后利用UBM进行不同时间观察研究，根据检查时间不同，分为术后6月内、6～12月、12～24月、24～36月及大于36月等时间段，记录术前、术后UBM检查时眼压，UBM下滤过泡形态，减压腔变化情况，小梁膜变化情况等，进行观察分析。结果 在6月、6～12月、12～24月、24～36月及大于36月的不同时间段内分别有53、28、37、24、21眼次（共163眼次）行UBM检查，其中有34例37眼有做两次及以上UBM检查；6月内H型滤过泡较多（40／53），而6月后明显减少，L型则较多（72／110）。在检查时IOP〉21mmHg或需加用药物控制眼压的28眼中，18眼为F型滤过泡，减压腔随时间延长逐渐减小，纤维增殖较多见于周边及植入物处，小梁膜变化主要表现为增厚、粘连及凹曲，在有做2次或以上UBM检查的眼中，有9眼可见小梁膜不同程度增厚，12眼小梁膜与巩膜壁粘连。结论 非穿透小梁手术后房水引流机制可能主要是结膜下滤过，术后失败原因主要是结膜下瘢痕化、小梁膜粘连、增厚及通透性下降。利用UBM可较好的了解滤过道的变化情况。     

非穿透小梁切除膨体聚四氟乙烯植入治疗开角型青光眼1例

洪××　女　 49岁　双眼患开角性青光眼 ,于 2 0 0 0年 9月 4日入住我院 ,住院号为 1194。术前视力为右眼 0 8,左眼0 7。眼压 3 6～ 42mmHg ,c/d =0 7,视野正常。次日在局麻下左眼行非穿透性小梁切除联和膨体聚四氟乙烯植入手术。 1个月后右眼行非穿透性小梁切除联和网状透明质酸钠生物胶植入手术。术后随访 2年 ,对比观察视力、眼压、滤泡、晶状体、视野和超声生物显微镜 (UBM )等变化 ,现报告如下 :手术在显微镜下做以角膜缘为基底的结膜瓣 ,约 8×15mm大小 ,分离至角膜缘内 2mm处。做浅层巩膜瓣 ,结膜瓣下做以角膜缘为基底的巩膜瓣…     

非穿透性小梁切除术疗效分析及前节OCT随访观察

目的 研究非穿透性小梁手术(non-penetrating trabecular surgery,NPTS)联合透明质酸钠 凝胶或羊膜植入术治疗开角型青光眼的临床效果,并探讨前节OCT在NPTS术后随访中的作用.方法 临床病例自身对照研究.对2006年5月至2009年11月在温州医学院附属眼视光医院就诊的42例(48只眼)开角型青光眼患者进行NPTS联合透明质酸植入物或生物羊膜治疗,其中11只眼联合羊膜植入,37只眼联合透明质酸植入.术后观察视力、眼压、并发症及滤过泡形态.随访时间6～48月,平均(18.56±11.49)月.末次随访时进行前节OCT观察残留的小梁网-狄氏膜、巩膜池和滤过泡等情况.结果 术前最高眼压平均(38.38±10.60)mmHg,术后第1天眼压,平均(8.59±3.51)mmHg,末次随访眼压(19.91±9.28)mmHg,术后不同时间段眼压较术前相比均下降,差异有统计学意义(P＜0.05).末次随访时视力与术前不变者36只眼(75.0%),视力下降者5只眼(10.4%),视力提高者7只眼(14.6%).末次随访时完全成功26只眼(54.2%),条件成功17只眼(35.4%),失败5只眼(10.4%).术后6只眼出现前房变浅,3只眼前房少许出血,均无明显前房炎性反应、持续性低眼压及脉络膜上腔出血等并发症发生.前节OCT可以清晰地观察到残留的小梁网-狄氏膜、巩膜池、巩膜瓣上液间腔、滤过泡壁厚度等.结论 NPTS联合透明质酸或生物羊膜植入物能较有效降低眼压,手术并发症少.前节OCT可以作为NPTS术后随访的一种安全无创的检查工具.

Abstract：

Objective To evaluate the effectiveness of non-penetrating trabecular surgery (NPTS)combined with reticulated sodium hyaluronate or amnion implant for open angle glaucoma and the value of anterior segment optical coherence tomography (AS-OCT) in the follow-up of NPTS. Methods NPTS was performed on 48 eyes of 42 patients, among whom 37 eyes with reticulated sodium hyaluronate implant, 11 eyes with amnion implant. Main outcome measures included visual acuity, intraocular pressure (IOP), filtering blebs and complications. The follow-up period was 6 to 48 months (mean 18.561 11.49 months). Anterior chamber OCT was undertaken to evaluate the rudimental trabecular reticulum-descement membrane, bleb and scleral cavity of the surgical site on the last follow-up time. Results The IOP was decreased from a mean preoperative value of (38.38±10.60) mmHg to a mean postoperative value of (8.59± 3.51) mmHg and (19.91± 9.28) mmHg on the first day and on the last visit respectively. Postoperative IOP at every visit point was lower than the preoperative value (P <0.01), 36 eyes (75.0%) remained stable visual acuity on the last visit compared with preoperative visual acuity, 5 eyes (10.4%) decreased and 7 eyes (14.6%) elevated. The complications such as inflammation, suprachoroidal hemorrhage and persistent hypotention were not observed except 6 flat chambers and 3 moderate anterior chamber hemorrhage. The completely successful rate on last visit was 26 eyes (54.2%),conditional successful rate was 17 eyes(35.4%)and failure 5 eyes(10.4%).The anterior segment OCT could be observed the rudimental trabecular reticulum-descement membrane,scleral cavity,suprascleral cavity and bled thickness,et al.Conclusions Non-penetrating trabecular surgery with reticulated sodium hyaluronate or amnion implant can effectively lower the IOP without severe complications.Anterior segment OCT is a safe and atraumatic tool for NPTS follow up.     

脐带静脉管联合MMC在非穿透性小梁手术中的应用

目的:研究人脐带静脉管(HUV)植入联合应用丝裂霉素C(MMC)在非穿透性小梁手术(NPTS)中应用的临床效果。方法:选取中、晚期原发性开角型青光眼病例32例(46眼)。患者分为两组:HUV+MMC组(n=25),透明质酸生物胶(SKGEL)+MMC组(n=21);行非穿透性小梁手术,HUV+MMC组将HUV置于巩膜床内,SKGEL+MMC组将SKGEL缝合固定于巩膜床上。术后分别于1,2,4wk;2,6,12mo裂隙灯下观察术口愈合情况、滤过泡情况、前房炎症反应、前房深度、有无出血等。测量眼压、最佳矫正视力,计算手术成功率。结果:HUA+MMC组的术后眼压平均在16mmHg,HUA+MMC组与SKGEL+MMC组在术后1,2,4wk;2,6,12mo时P>0.05,差异无显著性;功能性滤过泡术后1wk～12mo时HUA+MMC组与SKGEL+MMC组比较无显著性差异(P>0.05),末次随访HUA+MMC组成功(完全成功和条件成功)21眼,成功率84%;SKGEL+MMC组成功18眼,成功率86%。两组末次随访手术成功率比较无显著性差异(P>0.05)。结论:HUV联合MMC在NPFS中对术眼有明显而稳定的降压作用,大大提高了NPTS的手术成功率。脐带静脉管取材方便,抗原性低,有良好的组织相容性,眼局部反应轻,无毒副作用,且与SKGEL植入物相比,价格便宜,是理想的NPTS中的植入物。     

非穿透性小梁手术联合透明质酸植入物治疗开角型青光眼

目的探讨非穿透性小梁手术(non-penetratingtrabecularsurgery,NPTS)联合网状透明质酸植入物的临床疗效.方法对25例(27只眼)原发性开角型青光眼(primaryopenangleglaucoma,POAG)患者进行NPTS联合透明质酸植入物治疗.术后观察眼压、眼内组织反应情况、滤过泡形态,并对手术区域进行超声生物显微镜(ultrasoundbiomicroscopy,UBM)和前房角镜检查.随访时间3.0～10.4个月,平均(6.61±2.47)个月.结果患者术前眼压平均(26.36±9.02)mmHg(1mmHg=0.133kPa),术后3个月眼压平均(14.18±3.51)mmHg,差异有显著性(t=6.875,P<0.05).术后无需药物治疗而眼压≤21mmHg者占56.0%,需局部应用药物治疗或术区行残存小梁网激光穿刺治疗眼压≤21mmHg者占44.0%.术前局部应用降眼压药平均(2.96±1.43)种,术后减至(0.77±1.07)种,差异有显著性(t=4.716,P<0.05).所有患者术前、后视力差异均无显著性(χ2=0.33,P=0.564).27只眼中,6只眼术后眼压≥21mmHg,4只眼有轻微前房出血;无前房变浅、炎症、脉络膜脱离等并发症发生.UBM检查结果显示所有患眼在巩膜瓣下均形成一内含植入物的透明液性间腔,透明质酸植入物在术后3个月开始降解,其透明性间腔逐渐缩小,部分患者结膜下伴有滤过泡形成.前房角镜检查显示患眼术区小梁网明显变薄及有透明间腔样改变者23只眼,4只眼术区呈半透明样脱色改变.结论NPTS联合透明质酸植入物能有效降低眼压、减少局部应用抗青光眼药物的种类和剂量,无穿透性小梁手术常见的严重并发症发生,术后视力变化不明显,是一种治疗POAG的有效方法.     

一种新的技术——非穿透性小梁手术初步临床报告

OBJECTIVE: To evaluate the clinical effect of nonpenetrating trabecular surgery with sodium hyaluronate gel implant in Primary Open-Angle Glaucoma(POAG). METHODS: Twenty-four eyes of 22 patients with medically uncontrolled POAG were underwent nonpenetrating trabecular surgery with hyaluronate gel implant. The procedure was performed involing excising a deep-sclera tissue that flush with innerwall of Schlemm' s canal without opening the anterior chamber, then placing a 3 mm x 4.5 mm x 0.5 mm or 3.5 mm x 3.5 mm x 3.5 mm sodium hyaluronate gel implant under the scleral flap respectively. The postoperative Intraocular Pressure (IOP), Inflammation and fitering bleb were analysised. All of patients were undertaken ultrasound biomicroscopy (UBM) to evaluate the surgery site on postoperative 1-3 months. Mean follow-up was 3.9 +/- 2.2 months. RESULTS: The IOP decreased from a mean preoperative value of 24.4 +/- 9.1 mmHg to a mean postoperative value of 15.1 +/- 3.7 mmHg (P < 0.01). The number of anti-glaucomatous medications by topically or systemically was reduced from preoperative sorts of 2.8 +/- 1.4 to postoperative sorts of 0.7 +/- 1.0 (P < 0.01). The visual acuity remained stable, 6 eyes had IOP elevated and 2 eyes had occured hyphema. The complications such as flat chamber, inflammation and detachment of choroid were not observed. The UBM showed that the hyaluronate gel implant wasn't degraded and a transparent liquid space was formed under the scleral flap in all of patients on postoperatively 1-3 month. The filtering blebs were formed in some patients. CONCLUSION: Nonpenetrating trabecular surgery with hyaluronate gel implant can effectively lower IOP and reduce the number of anti-glaucomatous medications. No severe complications occured. With a simple postoperative nursing, it can be performed in clinic. It is proved to be a promising and new special technique to treat glaucoma.     

醛化脐带静脉管在兔眼非穿透性小梁手术中的应用

目的:观察脐带静脉管在兔眼非穿透性小梁手术(non-pen-itrating trabecular surgery,NPTS)中抗瘢痕化及其毒副作用。方法:对30只家兔双眼行NPTS,按照自身对照原则,术中一眼于深层巩膜切除处放置经醛化脐带静脉管组成实验组,另一眼不植入为对照组。术后观察眼压、滤过泡和眼局部反应,并做组织学及超声生物显微镜(UBM)检查。结果:术后1～5wk滤过泡存留例数实验组大于对照组(P<0.05);术后3d及6wk以后两组差异无显著性。术前眼压两组差异无显著性,术后1～8wk实验组低于术前,对照组术后1～2wk眼压低于术前(P<0.05),术后1～8wk实验组平均眼压低于对照组(P<0.05)。对照组术后2wk减压房被纤维组织充填,滤过道关闭,实验组术后28wk房水减压房内仍可见脐带静脉管,与周围瘢痕组织不发生紧密粘连,滤过道仍存在。术后1～28wkUBM检查脐带静脉管未降解,减压房仍然存在。术后:前房出血2眼(两组各1例),高眼压1眼(对照组),其余两组在观察期内均无明显炎症反应,植入物未见裸露及被排出现象。结论:醛化脐带静脉管可在家兔非穿透性小梁手术中防止滤过道粘连,维持巩膜间腔的存在,有效地降低眼压,无免疫排斥反应。     

非穿透性小梁手术联合醛化脐带静脉管植入及MMC治疗POAG

目的:评价非穿透性小梁手术(non-penetrating trabecular surgery,NPTS)联合醛化脐带静脉管(human umbilical vein,HUV)植入和丝裂霉素C(mitomycin C,MMC)治疗原发性开角型青光眼(primary open angle glaucoma,POAG)的临床疗效。方法:对42例42眼POAG患者进行NPTS联合HUV植入和MMC治疗。术后观察指标包括:术后眼压、术后抗青光眼药物应用、术后滤过泡形态学以及术后并发症,随访时间12mo。结果:术后12 mo,手术完全成功81%,条件成功95%;眼压从术前(26.1±7.7)mmHg降至(15.3±3.8)mmHg(P=0.00);抗青光眼药物从术前(3.2±0.5)种减少到(0.3±0.2)种(P=0.00);滤过泡形态,Ⅰ型滤过泡26%,Ⅱ型滤过泡59%,Ⅳ型滤过泡14%。术后6眼出现包裹性滤过泡,3眼有轻微前房出血,无浅前房、低眼压和脉络膜脱离等并发症发生。结论:NPTS联合HUV植入和MMC治疗POAG,具有手术成功率高,术后IOP控制良好,术后并发症发生率低的特点。     

Flap suture - a simple technique for the revision of hypotony maculopathy following trabeculectomy with mitomycin C

Background A serious complication following trabeculectomy with mitomycin C (MMC) is intraocular hypotony with hypotony maculopathy, papilledema, flattening of the anterior chamber, corneal decompensation and a decrease in visual acuity. We describe a new simple surgical technique for the treatment of hypotony maculopathy following trabeculectomy with MMC. Methods In a prospective consecutive case study, 16 patients with hypotony maculopathy following trabeculectomy with MMC were included. Through the intact conjunctiva, additional 10.0 nylon sutures were placed through the scleral flaps into the adjacent sclera. Assessment of visual acuity, intraocular pressure (IOP) measurement and fundoscopy were performed on the 1st and 7th day postoperatively and 1, 3 and 6 months postoperatively. Photography of the bleb and the posterior pole and optical coherence tomography imaging of the posterior pole were performed. Results Before surgery (flap suture), the mean IOP was 2.8 mmHg (±1.1; range from 1 to 4 mmHg). It was 24.9 ± 11.7 mmHg (range; 9–48 mmHg) on the 1st postoperative day, 15.7 ±8.1 mmHg (range; 5–35 mmHg) on day 7, 11.1 ±4.1 mmHg (range; 5–20 mmHg) 1 month after surgery, 9.3 ±3.9 mmHg (range; 2–20 mmHg) after 3 months, and 9.6 ±4.2 mmHg (range; 2–20 mmHg) after 6 months. The best corrected mean visual acuity was 20/50 before trabeculectomy and 20/160 before flap suture. It improved to 20/63 at 6 months postoperatively. Clinical signs of hypotony maculopathy disappeared in all patients. No bleb leakage was observed in any patient during follow-up. Conclusion Resuturing the scleral flap through the intact conjunctiva is an effective and minimally invasive method to treat hypotony maculopathy following trabeculectomy with MMC. Thus, opening the conjunctiva can be avoided. The authors have no financial interest in the subject of this paper.     

Does the dissection depth and thickness of the deep scleral flap affect intraocular pressure after viscocanalostomy? A clinico-pathologic correlation

BACKGROUND: Non-perforating glaucoma surgery preserves the integrity of the trabecular meshwork in order to avoid postoperative hypotony. The purpose of our study was to investigate whether the morphologic variability of the excised deep scleral flap influences the postoperative intraocular pressure (IOP) after viscocanalostomy. METHODS: Light-microscopy of the deep scleral flap was performed in 17 patients who had undergone viscocanalstomy. Morphologic parameters (thickness and dissection level of the deep scleral flap) were correlated with the postoperative IOP. RESULTS: The mean thickness of the deep scleral flap was 309 +/- 95 microns; the dissection level was too deep in 5 cases (trabecular tissue excised) and too high in 6 cases (no signs of Schlemm's canal). The max. preop. IOP was 36.2 +/- 8.5 mmHg and came down to 10.6 +/- 5.7 mmHg at day 1 postop. and 12.4 +/- 4.9 mmHg at day 3/4 postop. At a median follow-up of 6 months IOP was 21.7 +/- 5.5 mmHg. A significant correlation between postop. IOP and the morphology of the deep scleral flap could not be demonstrated. CONCLUSIONS: Variations of the thickness and depth of the deep scleral flap showed little influence on the initial IOP level following viscocanalostomy. Other factors, f.e. the suturing of the external flap or invisible microruptures of the trabecular meshwork, could be of importance for the early postoperative IOP.     

非穿透性小梁手术联合双层羊膜植入物治疗青少年型青光眼

目的　探讨非穿透性小梁手术 (NPTS)联合羊膜植入物治疗青少年型青光眼的临床效果。方法　对 2 6例 (32只眼 ) 12～ 2 8岁青少年型青光眼患者进行非穿透性小梁手术联合羊膜植入物治疗。术后观察患者眼压、眼内反应及滤过泡情况 ,并做前房角镜检查。患者术后平均随访时间 (8 3± 4 2 )个月。结果　患者术后视力较术前无明显变化。患者术前平均眼压 (2 8 6± 7 3)mmHg(1mmHg =0 133kPa) ,术后 (15 7± 3 7)mmHg ,差异有显著意义 (t=4 82 ,P <0 0 1)。术前用药2～5种 ,平均 3 2种 ;术后用药 0～ 2种 ,平均 0 8种 ,差异有显著意义 (秩和检验 ,t=12 8,P <0 0 1)。随访期间眼压≤ 2 1mmHg者 30只眼 (93 8% ) ,无需药物治疗而眼压正常者 18只眼 (5 6 3% ) ,用药后眼压保持正常者 12只眼 (37 5 % )。术后 6只眼有轻微前房出血 ;无前房变浅、眼部炎性反应、脉络膜脱离等并发症发生。术后患者经前房角镜检查 ,可见术区后弹力膜及残存小梁网变薄 ,5只眼可见小梁处有微穿孔。结论　NPTS联合羊膜植入术能有效降低眼压 ,减少抗青光眼药物的应用 ,术后并发症少 ,是治疗青少年型青光眼的有效方法之一。     

经烧烙自体巩膜在非穿透性小梁手术中应用的研究

目的 观察非穿透性小梁手术（Nonperforating trabecular surggery，NPTS）联合经烧烙自体巩膜植入术治疗青光眼的临床效果。方法 将39例（48眼）原发性开角型青光眼患者分为两组，实验组：NPTS＋经烧烙自体巩膜植入，对照组：单纯NPTS。术后观察眼压、视力、滤过泡形态、并发症等，并做超声生物显微镜（UBM）观察。结果 经12个月随访成功率实验组为91．7％，对照组为66．7％。术后1～12个月实验组眼压明显低于对照组（P＜0．01）。术后3～12个月实验组功能性滤过泡及减压室存留情况均多于对照组（P＜0．05），术后6～12个月实验组睫状体脉络膜上腔低回声暗区多于对照组（P＜0．05）。结论 非穿透性小梁手术联合经烧烙自体巩膜植入术，能有效降低眼压，经济安全术后视力稳定，值得临床应用推广。