青光眼小梁切除术后并发症临床分析

目的探讨小梁切除术后早期并发症的发生原因、治疗方法及效果。方法青光眼小梁切除术47例（52眼）。术中前房穿刺维持安全眼压,并采用巩膜瓣调整缝线控制术后浅前房,获得功能型滤过泡和理想的眼压控制。结果小梁切除术后早期并发症的发生率为44．23％（23／52）;其中浅前房12眼,虹膜睫状体炎5眼,前房积血2眼,脉络膜脱离1眼,结膜渗漏1眼。对其中22眼采取保守治疗,治愈19眼。结论小梁切除术后早期并发症的保守治疗效果显著。明确青光眼小梁切除术后常见并发症的原因,采取有效的措施积极处理,可降低手术风险,减少术后并发症。     

三种抗青光眼手术后浅前房临床分析

目的讨论小梁切除术、巩膜咬切术和虹膜嵌顿术后浅前房的原因和发生情况。方法回顾性总结１９８６～１９９６年在我院眼科进行３种抗青光眼手术的３９０只各种青光眼病例。结果（１）术前眼压≤２１ｍｍＨｇ（１ｍｍＨｇ＝０．１３３ｋＰａ）者１０９只眼，小梁切除术６４只眼，术后浅前房９只眼，占１４．１％，巩膜咬切术３１只眼，术后浅前房７只眼，占２０．６％，虹膜嵌顿术１１只眼，术后无浅前房发生；（２）术前眼压２２～３５ｍｍＨｇ者１７５只眼，小梁切除术１０３只眼，术后浅前房２６只眼，占２５．２％，巩膜咬切术４６只眼，术后浅前房１５只眼，占３２．６％，虹膜嵌顿术２６只眼，术后浅前房５只眼，占１９．２％；（３）术前眼压＞３５ｍｍＨｇ者１０６只眼，小梁切除术４２只眼，术后浅前房１３只眼，占３１％，巩膜咬切术２３只眼，术后浅前房５只眼，占２１．７％，虹膜嵌顿术４１只眼，术后浅前房５只眼，占１２．２％．结论３种抗青光眼手术中，虹膜嵌顿术后浅前房发生率低；术前眼压控制正常后，术后浅前房发生率低。     

可松解缝线的小梁切除术

目的 观察可松解缝线的小梁切除术能否减少小梁切除术后的并发症。方法 48例（72眼）青光眼患者随机分为2组：观察组33眼行可松解缝线的小梁切除术,对照组39眼行常规小梁切除术,术后观察比较眼压、滤过泡、前房深度、视力及其他眼部并发症。结果 在术后低眼压、浅前房、视力下降的发生率观察组分别为6．06％,12．12％和6．06％,而对照组分别为28．21％,30．77％和26．64％（P＜0．05）,而且观察组前房积血、脉络膜脱离、并发性白内障及虹膜睫状体炎的发生也明显少于对照组。结论 可松解缝线的小梁切除术可有效地控制术后滤过水平而减少小梁切除术后并发症的发生。     

小梁和巩膜切除术联合睫状体上腔引流治疗无晶状体和人工晶状体青光眼

目的探讨联合睫状体上腔引流的小梁和巩膜切除（LSEVDS）治疗无晶状体和人工晶状体眼青光眼的效果。方法采用回顾性方法观察103例（109眼）无晶状体和人工晶状体眼的青光眼患者。26例（26眼）无晶状体眼和34例（36眼）人工晶状体眼患者行LSEVDS，另外19例（20眼）无晶状体眼和24例（27眼）人工晶状体眼患者行传统小梁切除术。平均随访12．6个月，比较了术后视力、眼压（IOP）、视野、前房深度、滤过泡形态、脉络膜脱离、前房出血等情况。结果术后12个月，LSEVDS使无晶状体眼和人工晶状体眼的眼压明显下降，降眼压效果比小梁切除术更显著，其差异有统计学意义（P〈0．05）。LSEVDS的并发症包括前房积血（11．2％）、脉络膜脱离（6．5％）、低眼压（19．2％）和浅前房（11．2％），均于2周内好转。术后患者视力的变化无统计学意义。结论在治疗无晶状体和人工晶状体眼青光眼方面，LSEVDS的效果优于传统小梁切除术。     

青光眼小梁切除术后早期并发症分析及处理

目的探讨青光眼小梁切除术后早期并发症及处理。方法总结5年来小梁切除术114眼，统计和分析了小梁切除术后早期并发症和常见原因。结果并发症42眼（36．84％），浅前房22眼（19．30％）、虹膜睫状体炎9眼（7．89％）、前房积血4眼（3．51％）、角膜上皮水肿3眼（2．63％）、脉络膜脱离1眼（0．88％）、术后眼压控制不良3眼（2．63％）。结论明确青光眼小梁切除术后早期并发症原因、正确处理方法，可以达到预防治疗青光眼小梁切除术后早期并发症的目的，从而提高手术成功率。     

抗青光眼术后浅前房相关因素分析及处理

目的探讨抗青光眼术后浅前房与术前眼压及手术方式的关系；分析与术后结膜伤121渗漏、滤过过强及脉络膜脱离的关系。方法回顾性总结各类型青光眼的抗青光眼手术236例（278眼）术后发生浅前房的情况。结果发生浅前房49眼（17．63％）。术前眼压≤21mmHg者183眼中发生浅前房17眼（9．29％），术前眼压22—35mmHg者57眼发生浅前房15眼（26．32％），术前眼压≥35mmHg者38眼巾发生浅前房17眼（44．74％）。小梁切除术185眼中术后发生浅前房26眼（14．54％），巩膜咬切术93眼中浅前房23眼（24．73％）。术后结膜渗漏9眼（18．37％），滤过过强20眼（36．73％），脉络膜脱离5眼（10．20％），另有原因不明者15眼。结论抗青光眼术后浅前房与多种因素有关。（1）术前眼压控制正常者，发生率低；（2）小梁切除较巩膜咬切术发生率低；（3）以滤过过强性者为最多。     

青光眼滤过术后低眼压性浅前房原因探讨

目的 分析青光眼滤过术后发生低眼压性浅前房的原因,以减少浅前房的发生。方法 292例(345只跟)青光眼行小梁切除和虹膜根切术,对其病历进行回顾性分析。结果 (1)发生浅前房共69只眼(20％),其中低眼压性浅前房65只眼(94．2％)；(2)在低眼压性浅前房病例中，眼压≤5mmlHg者60只眼(92．3％)．眼压在5～10mmHg者5只眼(7．7％)：(3)在低眼压性浅前房中脉络膜脱离者48只眼(73．8％),其它原因17只眼(26．2％)；(4)在低眼压性浅前房病历中．术前房角开放≤窄Ⅱ者46只眼(70．8％),≥窄Ⅲ者19只眼(29．2％)。结论 高滤过、低眼压房水动力学改变是低眼压性浅前房形成最初的基本原因．而脉络膜脱离则是低眼压性浅前房形成最主要原因。     

青光眼滤过术后浅前房的临床探讨

目的 讨论青光眼滤过术后浅前房形成的常见原因及处理方法。方法 回顾性总结北京同仁医院青光眼组1998年10月～1999年10月期间连续收治的352例青光眼住院患者行青光眼滤过性手术后发生浅前房的原因、类型及处理方法。结果 共行青光眼滤过性手术495只眼，其中117只眼发生浅前房，发生率为23．64％。小梁切除术为19．2％(15／78)，小梁切除术 MMC为32％(93／291)，青光眼联合白内障的三联手术为7．1％(9／26)。浅前房发生在术后1～7天，其中滤过过畅36只眼(30．77％)、睫状体脉络膜脱离34只眼(29．06％)、结膜瓣渗漏27只眼(23．08％)、恶性青光眼15只眼(12．8％)、恶性青光眼合并睫状体脉络膜脱离3只眼(2．56％)、脉络膜上腔出血2只眼(1．71％)。需要手术治疗的35只眼，其余82只眼仅通过保守治疗均能恢复前房。结论 青光眼滤过术后浅前房发生率较高，其常见原因是房水滤过过畅、结膜瓣渗漏及睫状体脉络膜脱离。以小梁切除术 MMC的发生率最高，MMC不但能阻止滤过泡的纤维化，而且能使房水分泌减少。大多数浅前房可通过保守治疗治愈。     

术中调整巩膜瓣缝线预防小梁切除术后浅前房的探讨

目的 探讨术中调整巩膜瓣缝线预防小梁切除术后浅前房的效果。方法 将135例(178只眼)原发性青光眼随机分成A、B组，每组均为89只眼。A组术中调整巩膜瓣缝线；B组术中不调整巩膜瓣缝线。观察术后视力、滤过泡、角膜、前房、晶状体、眼底、眼压等。结果 A组浅前房发生率为7．88％；随访6～18个月，眼压控制率为91．01％。B组浅前房发生率为32．57％；眼压控制率为73．03％。两组间浅前房发生率、眼压控制率对比有显著差异。结论 在小梁切除术中调整巩膜瓣缝线能有效地降低术后浅前房的发生率和提高手术的成功率。     

青光眼睫状体炎综合征的手术疗效观察

目的 探讨非穿透性小梁手术治疗有青光眼性视神经损害的青光眼睫状体炎综合征的疗效。方法 对8例（8只眼）出现青光眼性视神经损害的青光眼睫状体炎综合征患者行非穿透性小梁手术。术后观察并发症和睫状体炎复发情况，检查视力、眼压、眼底和视野。术后随访12．0～48．0个月，平均（34．42±7．04）个月。结果 7只眼术后眼压维持在10～20mmHg之间，眼压控制成功率为87．50％。术后6只眼无睫状体炎复发，睫状体炎控制率为75．00％。眼压控制良好的7只眼，术后视力、视野和C／D比值与术前相同。无浅前房，脉络膜脱离，眼内炎等并发症。结论 非穿透性小梁手术能有效地降低眼压和控制睫状体炎的复发，防止青光眼性视神经损害进一步加重，且术后无严重并发症，是治疗出现青光眼性视神经损害的青光眼睫状体炎综合征的有效方法。     

大节段小梁切除术治疗新生血管性青光眼

目的 评价大节段小梁切除术治疗新生血管性青光眼的临床效果。方法 对23例(23眼)新生血管性青光眼采用大节段小梁切除术，术后给予视网膜光凝或虹膜根部新生血管直接光凝。术后随访6～24月，平均18月。结果 出院时眼压：5～21mmHg者21眼(91．3％)，小于5mmHg者2眼(8．7％)。全部形成功能型滤过泡，2眼视力下降，6眼视力提高。随访眼压：5～21mmHg者19眼(82．6％)，其中5眼须局部滴用降低眼压药物。小于5mmHg者1眼(4．3％)，3眼眼压升高(13．0％)。术后早期并发症主要有前房积血(39．1％)和浅前房(47.8％)，后期主要有滤过区巩膜葡萄肿(30．4％)。结论新生血管性青光眼需要手术、激光、药物等综合治疗，大节段小梁切除术是疗效较好手术方法。     

Deep sclerectomy augmented with combination of absorbable biosynthetic sodium hyaluronate scleral implant and mitomycin C or with mitomycin C versus trabeculectomy: long-term results

Background: To evaluate the long‐term results following deep sclerectomy with mitomycin C‐SKgel implant (DSMMC‐SKgel), mitomycin C (DSMMC) and trabeculectomy. Design: Comparative case series, Goztepe Training and Educational Hospital. Participants: Ninety‐one open‐angle glaucoma patients. Methods: DSMMC‐SKgel, DSMMC and trabeculectomy operations were performed in 28, 30 and 33 eyes, respectively. Main Outcome Measures: Intraocular pressures (IOP) and distance corrected visual acuities (DCVA) were measured preoperatively and postoperatively at days 1, 7 and months 1, 3, 6, 12, 18, 24, 30, 36, 48. Results: At month 48, deep sclerectomy groups had better DCVAs, and in all groups mean IOPs and number of medications were significantly lower and DCVAs were worse than preoperative values. Mean IOPs in trabeculectomy group at week 1, months 1 and 3 were significantly lower than those in DSMMC group. Mean IOPs in DSMMC‐SKgel group at week 1 and month 1 were significantly lower than those in DSMMC group. Mean preoperative IOPs, postoperative IOPs following 3rd month, complete (IOP ≤ 21 mmHg and ≤18 mmHg without medication) and qualified (IOP ≤ 21 mmHg and ≤18 mmHg with or without medication) success rates of all groups were not statistically different. Rate of complications such as hyphema, hypotony, shallow anterior chamber, bleb leak, bleb fibrosis, cataract, choroidal detachment and macular oedema were found to be significantly higher in trabeculectomy group (P < 0.05). No significant difference in the mean post‐laser goniopuncture IOPs was found between the two deep sclerectomy groups during the follow up. Conclusions: DSMMC, DSMMC‐SKgel and trabeculectomy operations were almost equally effective in lowering IOP at long‐term follow up, but complication rates were higher after trabeculectomy operations.     

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     

Nonpenetrating deep sclerectomy versus trabeculectomy in bilateral primary open-angle glaucoma

OBJECTIVE: To establish the efficacy and safety of nonpenetrating deep sclerectomy versus trabeculectomy in primary open-angle glaucoma. DESIGN: Prospective randomized trial. PARTICIPANTS: Thirty-nine patients (78 eyes) with bilateral primary open angle glaucoma were included in the study. INTERVENTION: Eyes were randomly assigned to receive deep sclerectomy in one eye and trabeculectomy in the other eye. MAIN OUTCOME MEASURES: Mean intraocular pressure (IOP), postoperative medications, visual acuity, success rate, and complications. RESULTS: At 12 months, mean IOP reduction was 12.3 +/- 4.2 (sclerectomy) versus 14.1 +/- 6.4 mmHg (trabeculectomy) (P = 0.15), and an IOP 相似文献   

Internal sclerectomy with an automated trephine for advanced glaucoma

An automated trephine (trabecuphine) was used to perform an internal sclerectomy in seven glaucoma patients who were aphakic or had undergone previous filtering surgery that had failed or both. A patent fistula was achieved intraoperatively in all seven eyes. Postoperatively, six patients received subconjunctival injection of 5-fluorouracil (5-FI) once daily for an average of 8 days. Five of seven patients have retained a functional bleb and a controlled intraocular pressure (IOP) after surgery (follow-up, 4-24 months). The only intraoperative complication was hemorrhage from the sclerectomy site in a patient with aniridia that resulted in a 20% hyphema. The hyphema cleared quickly, and the bleb has remained functional with a pressure of 12 mmHg for 9 months. The trabecuphine makes it possible to perform a glaucoma filtering operation safely from within the anterior chamber. This technique minimizes conjunctival trauma in the filtration area. The absence of a conjunctival incision overlying the fistula simplifies the adjunctive use of antimetabolites such as 5-FU.     

小梁切除术后无功能滤过泡患者眼压正常的机制探讨

目的初步探讨小梁切除术后无功能滤过泡患者眼压控制正常的机制。方法对小梁切除术后无功能滤过泡,但眼压控制正常的16名患者进行包括一般眼科检查、UBM检查及前房角镜检查,寻找可能的房水排除途径。结果所有16只眼为瘢痕型滤过泡,虹膜周切孔通畅;UBM检查滤过泡区域未发现结膜瓣及巩膜瓣下潜在腔隙;前房角镜检查全部患者内滤过口阻塞、房角开放均>1/2周。结论小梁切除术后无功能滤过泡但眼压控制良好眼可能并不存在特殊的房水引流途径,其原因多是由于术前对患者的手术方式选择不当或手术适应症掌握不当。     

视网膜睫状体冷凝联合小梁切除术治疗新生血管性青光眼

目的评价广泛视网膜睫状体冷凝联合丝裂霉素C及小梁切除术治疗新生血管性青光眼的临床效果。方法采用广泛视网膜睫状体冷凝联合丝裂霉素C及小梁切除术治疗新生血管性青光眼20例（20眼），观察术后眼压、视力及并发症等。结果术后随访6个月～1a，18眼眼压得以控制；各眼视力无明显变化；功能滤过泡占80％：出现一过性高眼压、前房积血等并发症，经对症处理，均在1周内恢复。结论广泛视网膜睫状体冷凝联合丝裂霉素C及小梁切除术治疗新生血管性青光眼可以有效控制眼压。     

青光眼非穿透性小梁切除术的临床研究

目的分析非穿透性小梁切除术对开角型青光眼的手术效果,手术并发症及其房水引流机制。方法POAG组男22例(24眼),女24例(26眼),共46例(50眼)行NPT手术,PACG组男22例(24眼),女26例(27眼),共48例(52眼)行小梁切除术。比较两组术后眼压及并发症,随访3～18月。结果POAG组术中有4眼发生小梁-后弹力层微穿孔(8％),术后 2月眼压<21mmHg(1mmHg=0.133kPa)有44眼(88％),有2眼发生浅前房,6眼眼压升高,无前房出血,11眼结膜形成滤过手术典型滤过泡,28眼结膜疏松,无滤过泡形成,PACG组术后2月有38眼眼压<21mmHg(73％),并发症发生14眼(27％),其中浅前房5眼,前房出血4眼,脉络膜脱离2眼,黄斑部囊样水肿3眼,均有明显的结膜滤过泡形成。术后随访3-18月,眼压下降幅度POAG组44.5％,PACG组29.6％。结论NPT是一种降眼压效果较好并发症较少的青光眼滤过性手术疗法。     

Risk profile of deep sclerectomy for treatment of refractory congenital glaucomas

OBJECTIVES: To evaluate the effectiveness and risk profile of deep sclerectomy in surgery for refractory congenital glaucoma. DESIGN: Retrospective non-comparative interventional case series. PARTICIPANTS AND INTERVENTIONS: Ten eyes of eight consecutive patients underwent deep sclerectomy for refractory congenital glaucoma. The procedure was converted to a trabeculectomy in four eyes and supplemented by a trabeculotomy in two eyes. Six eyes had primary congenital glaucoma, and four eyes had secondary congenital glaucoma. The patients' ages at the time of surgery in our department ranged from 8 months to 14 years. All eyes had a history of previous glaucoma surgery. MAIN OUTCOME MEASURES: The surgical outcome was assessed in terms of complication rate, intraocular pressure (IOP) change, need for surgical revision, or additional glaucoma medication. RESULTS: Preoperatively, the mean IOP was 31.9 mmHg (standard deviation [SD], 5.6 mmHg). At first follow-up 1 week after surgery, the mean IOP for all eyes was 12.7 mmHg (SD, 6.8 mmHg). The average reduction of IOP was statistically significant (P < 0.001). In accordance with the success criteria, all eyes were ultimately classified as failures. Average time to failure was 2.1 months (SD, 3.6 months). Specific complications were seen in terms of non-identification of Schlemm's canal (40%), choroidal deroofing (10%), and visible perforation of the trabeculodescemetic membrane (20%). Further complications were hyphema (40%), ocular hypotony (10%), vitreous hemorrhage (10%), and vitreous loss with subsequent retinal detachment (10%). CONCLUSIONS: Although deep sclerectomy may reduce the IOP in patients with refractory congenital glaucoma, this study indicates a specific risk profile associated with deep sclerectomy in surgery for refractory congenital glaucoma.     

小梁切除联合丝裂霉素治疗外伤继发性青光眼

目的观察小梁切除手术联合丝裂霉素治疗外伤继发性青光眼的临床效果。方法对19例（19眼）外伤继发性青光眼应用小梁切除术治疗,术中联合应用丝裂霉素。术后随访眼压、滤泡形态,视力,以及手术并发症。结果术后眼压均低于术前,滤泡在术后3～7d形成,形态良好。视力较术前有不同程度改善。并发症包括前房积血、浅前房,未出现严重的并发症。结论小梁切除术联合丝裂霉素治疗外伤继发性青光眼是一种安全、有效的治疗方法,在药物治疗无法控制眼压时,可以考虑应用该方法治疗。