小梁切开联合小梁切除术治疗先天性青光眼

目的 探讨小梁切开联合小梁切除术治疗先天性青光眼的疗效。方法 １９９８年１月至１９９９年５月,对２０例３６眼先天性青光眼患者施行外路小梁功开联合小梁切除术。结果 术后不用任何抗青光眼眼液或药物,眼压〈２．８ｋＰａ,角膜清晰,角膜直径和杯盘比值不进展,术后随访３￣１８个月,平均９个月,手术成功率为９４．７％。结论 小梁切开联合小梁切除术治疗先天性青光产单纯外路小梁切开术及房角切开术效果好,开辟内、外     

闭角型青光眼巩膜隧道下小梁切除术临床观察

目的探讨闭角型青光眼巩膜隧道下小梁切除术的临床效果。方法观察组44例（55眼）,施行巩膜隧道下小梁切除术。对照组58例（70眼）,施行三角形板层巩膜瓣下小梁切除术。结果术后视力观察组平均0．45,对照组平均o．38。术后眼压观察组出院时平均12mmHg,对照组出院时平均12mmHg。术后浅前房发生率：观察组13眼（23．64％）,对照组21眼（28．57％）,卡方检验x2=0．63,P〉0．05。术后包裹性滤过泡,观察组无,对照组5眼（7．14％）,卡方检验x2=4．09,P〈0．05。结论闭角型青光眼巩膜隧道下小梁切除术后视力稳定,眼压控制良好,浅前房发生率不高,包裹性滤过泡发生率低。     

隧道式小梁切除术治疗青光眼

我们采用改良隧道式小梁切除术对 4 8例 5 0眼青光眼进行治疗 ,并分阶段采用不同的方法促进前房及功能性滤过泡形成 ,取得了很好疗效 ,现报告如下。1　资料与方法1.1　一般资料　本组 4 8例 5 0眼 ,男 13例 13眼 ,女 35例37眼 ,年龄 4 2～ 81岁 ,平均 (5 8.0 1± 14 .90 )岁。急性闭角性青光眼 33例 35眼 ;慢性闭角性青光眼 15例 15眼。入院后测眼压、检查眼底、视野及房角等以确诊。1.2　方法　在手术显微镜下做以穹隆部为基底的结膜瓣 ,在巩膜上做 5 mm× 4 m m、1/ 3巩膜厚度的以角膜缘为基底的巩膜瓣 ,在其下方巩膜中央做一垂直角膜缘 5…     

外路小梁切开联合小梁切除术治疗先天性青光眼

目的：评价外路小梁切开联合小梁切除术治疗先天性青光眼的疗效。方法：应用外路小梁切开联合小梁切除术治疗婴幼儿先天性青光眼6例（11眼）。结果：术后7天,11眼眼压均降至正常。术后随访观察平均20个月,10眼眼压控制正常,手术成功率为90．9％。术中常见并发症为小量前房出血,一般在术后1－5日内完全吸收,对手术效果无影响。结论：外路小梁切开联合小梁切除术是治疗婴幼儿先天性青光眼安全而有效的手术方法,可推广应用。     

隧道刀制作巩膜瓣的青光眼小梁切除术临床观察

目的　探讨隧道刀制作巩膜瓣的青光眼小梁切除术临床疗效。方法　采取随机分组法 ,将 49例 ( 63只眼 )原发性闭角型青光眼分为治疗组 2 4例 ( 3 0只眼 )和对照组 2 5例 ( 3 3只眼 ) ,前者为隧道刀制作巩膜瓣的青光眼小梁切除术 ,后者为常规青光眼小梁切除术。随访 12个月。结果　术后 1年 ,治疗组与对照组对比 ,视力有显著差异 (χ2 =4.5 8,P <0 .0 5 ) ;功能性滤过泡经 t检验 ,有显著差异 ( t=3 .88,P <0 .0 5 )。治疗组的完全成功率和条件成功率分别为 90 .2 3 %和 97.3 6% ,对照组的完全成功率和条件成功率分别为 76.8%和 83 .2 7% ,两组有显著差异 ( u=2 .3 6,P <0 .0 5 )。结论　隧道刀制作巩膜瓣的青光眼小梁切除术显著延长了滤过泡的功能 ,有效降低了眼压 ,术后并发症少     

隧道式小梁切除术

小梁切除术与巩膜全层切除术相比 ,术后浅前房、脉络膜脱离和感染等并发症明显减少 ,但术后眼压下降幅度及持久性较巩膜全层切除术差。抗代谢药物的应用 ,虽然能提高手术成功率 ,但因其并发症明显而受到一定的局限 [1 ,2 ]。为此人们试图找到一种更安全、疗效更确切的方法 ,隧道式小梁切除术就是其中之一。1　资料与方法1.1　一般资料　病例来源于我院 1996年 4月～ 1998年 4月住院病人 ,5 8例 70眼首次行滤过性手术者。隧道式小梁切除 35眼 ,其中男 16眼 ,女 19眼 ,年龄 5 5 .70 a± 9.0 3a,术前眼压 4.0 4k Pa± 1.6 9k Pa,闭角型青光眼 …     

角巩膜瓣下小梁切除术临床观察

观察角巩膜瓣下小梁切除术的临床效果。方法分为角巩膜瓣下小梁切除联合浅层巩膜剪除术和联合浅层巩膜切开术两组进行手术。结果术后平均眼压２．４６ｋＰａ,２０眼眼压在正常范围,滤泡扁平弥散,１眼失败,滤泡不明显。无１眼发生角膜瓣渗漏。结论该术式近期效果好,适合于原抗青光眼手术失败及结膜条件差者。     

深层巩膜切除联合外路小梁切开治疗发育性青光眼

目的观察深层巩膜切除联合外路小梁切开治疗发育性青光眼的临床效果。方法选取31例(62眼)住院的双眼发育性青光眼患者,平均年龄(12.5±3.5)岁,均行自身对照,1眼行深层巩膜切除(non-penetratingdeepsclerec-tomy,NPDS)联合外路小梁切开及巩膜瓣下羊膜植入手术(称治疗组),术中巩膜瓣缝合4针;另1眼行常规的小梁切除手术(称对照组)。术后观察并记录视力、前房、眼压及滤过泡等情况。平均随访(13.5±4.6)mo。结果治疗组眼压完全控制率为77%(24/31),有效控制率为84%(26/31);对照组眼压完全控制率为81%(25/31),有效控制率为90%(28/31),χ2=0.14,P>0.05,差异无显著性。滤过泡情况治疗组功能型滤过泡9眼(29%),对照组功能型滤过泡25眼(81%),其中对照组有4眼为薄壁滤过泡而治疗组无1例发生,χ2=16.67,P<0.01,有高度显著性差异。结论深层巩膜切除联合外路小梁切开治疗发育性青光眼具有较高安全性且降眼压较可靠的特点,对青少年生存质量的提高有着重要的意义。     

巩膜层间隧道房水引流术治疗难治性青光眼

目的探讨巩膜层间隧道房水引流术治疗难治性青光眼的临床效果。设计前瞻性随机对照临床研究。研究对象 87例(98眼)难治性青光眼患者。方法将不同类型难治性青光眼患者随机分为2组,隧道组(50眼)行巩膜层间隧道房水引流术,在浅层巩膜下纵形切除5．0mm×1.5mm条状饭层巩膜和常规的小梁切除,条状巩膜远端超过巩膜床1．5-2．0mm,对照组(48 眼)行常规的小梁切除术。术后随访6-12个月。主要指标视力、眼压、滤过泡、术巾及术后并发症。结果 (1)术后视力隧道组和对照组比较差异无统计学意义(x2=1．15,P=0．76)。(2)术后1周两组眼压与术前相比差异有统计学意义,而组间比较差异无统计学意义(t=1.85,P=0．08);术后6个月隧道组平均眼压(14．34±3．95)mmHg.对照组(19．57±7．76)mmHg;手术成功率:隧道组 88．00％,对照组64．58％,差异均有统计学意义(P<0．05)。(3)隧道组功能性滤过泡82,0％,对照组60．4％,两组比较差异有统计学意义(x2=5．59,P=0．02)。(4)术后隧道组出现浅前房较对照组多,治疗后1周内恢复正常,没有其他并发症。结论对于难治性青光眼,与常规小梁切除术比较,巩膜层间隧道房水引流术在防止滤过道瘢痕形成,术后眼压控制等方面均有明显优势。     

小梁切除术联合自体巩膜植入术治疗青光眼的临床研究

目的观察小梁切除术联合自体巩膜植入术治疗青光眼的临床疗效。方法对12例(12眼)青光眼患者施行小梁切除术联合自体巩膜植入术。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,术后视力11眼(92%)维持不变或提高。眼压由术前平均(36.15±11.39)mmHg降至术后1a平均(13.21±4.98)mmHg,有非常显著性差异(P<0.01),末次随访眼压≤21mmHg者11眼(92%),其中9眼形成弥散性滤过泡,术后前房轻度变浅4眼,术后3～7dUBM检查睫状体脱离2眼,无其它并发症发生。结论小梁切除术联合自体巩膜植入术,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。     

小梁切除治疗急性原发性闭角型青光眼

目的　对比观察小梁切除术联合丝裂霉素C(mitomycin C ,MMC)和单纯小梁切除术治疗急性原发性闭角型青光眼的结果。方法　 67例 (67眼 )分为两组 ,分别采用小梁切除术联合MMC和单纯小梁切除术治疗。结果　术后随访时间 6～ 18月 ,平均 (11. 12± 3 . 5 7)月。小梁切除术联合MMC组 (3 5眼 ) ,眼压控制绝对成功率为 82 . 86%(2 9眼 ) ,相对成功率为 94 .2 9%(3 3眼 ) ;单纯小梁切除术组 (3 2眼 ) ,眼压控制绝对成功率为 5 9. 3. 8%(19眼 ) ,相对成功率为 75 . 0 0 %(2 4眼 ) ;两组在眼压控制方面的差异具有显著意义 (P <0 . 0 5 )。术后主要并发症是前葡萄膜炎和虹膜后粘连。结论　小梁切除术联合MMC是药物治疗无反应的急性原发性闭角型青光眼治疗可供选择的手术方法。     

小梁切除联合干扰素应用治疗新生血管性青光眼

目的 评价小梁切除术联合干扰素结膜下注射治疗新生血管性青光眼的临床应用效果。方法21例新生血管性青光眼，均采用巩膜瓣下小梁切除术，术后结膜下注射α-2b干扰素，隔日一次，共12次。结果所有患者随访1～2年，21例术后眼压均低于21mmHg(1mmHg=0．133kPa)。19例存在功能性滤过泡，虹膜及前房角处新生血管退缩无残留。结论小梁切除术联合干扰素应用是治疗新生血管性青光眼的有效方法。     

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。     

小梁切除联合后房型人工晶状体植入术治疗晶状体溶解性青光眼

晶状体溶解性青光眼是由成熟期或过熟期白内障的晶状体蛋白渗漏所致,常伴有疼痛和明显的前房炎症。小梁网被巨噬细胞和大分子量的晶状体蛋白所阻塞,应尽快药物降眼压并控制炎症。通常采用晶状体囊内冷冻摘出法治疗白内障［１］。我院在１９８９年～１９９６年将晶状体溶解性青光眼行小梁切除联合后房型人工晶状体植入术３６例３６眼,现将病例的疗效分析如下。１　资料和方法１．１　一般资料　本组患者３６例３６眼,均为单眼手术,其中男１５例,女１９例;年龄５７～７６ａ,平均为６５ａ。发病时期：白内障史１～１０ａ,平均４．５ａ…     

双切口三联手术治疗青光眼合并白内障的研究

目的探讨双切口三联手术治疗青光眼合并白内障的手术效果.方法对比分析了56例(60眼)青光眼合并白内障的临床资料,其中30眼行巩膜隧道式小切口白内障囊外摘出联合人工晶状体植入术,另作一切口行小梁切除术(双切口组);另30眼行白内障囊外摘出联合人工晶状体植入及小梁切除术(对照组).结果术后1月内,双切口组视力提高明显优于对照组(t=2.12287,P＜0.05);术后8月两组的眼压控制程度相似,但对照组需加用抗青光眼药物;功能性滤过泡的形成率两组间的差异有显著意义.结论提示巩膜隧道式小切口白内障手术联合另外切口小梁切除术组(双切口组)的临床效果良好.     

双直角切口小梁切除术临床分析

目的 探讨双直角切口小梁切除术的疗效。方法 通过２个直角形切口对２３例青光眼患者（２５眼）施行小梁切除术。结果 术后随访３～１０ｍｏ,眼压全部降至正常,均形成功能性滤过泡。结论 双直角切口小梁切除术优于传统手术,类似于角膜切口小梁切除术,但操作简单并发症少。     

Trabeculectomy with OloGen versus trabeculectomy for the treatment of glaucoma: a pilot study

Purpose: To present the preliminary results of our study comparing the outcomes of trabeculectomy with or without OloGen implant in patients requiring glaucoma surgery for uncontrolled intraocular pressure (IOP). Methods: Forty eyes of 40 patients were assigned randomly to undergo trabeculectomy either with OloGen implant (study group) or without implant (control group). Preoperative data included age, gender, type of glaucoma, IOP and number of preoperative glaucoma medications. Postoperative IOP, number of postoperative glaucoma medications and postoperative complications were recorded. Each patient was followed up for at least 6 months. Results: There were no significant differences between the groups in terms of age, gender, type of glaucoma, preoperative IOP and number of antiglaucoma medications. Mean IOPs for both groups were significantly lower than preoperative levels at all intervals (P < 0.05) The number of glaucoma medications used dropped from a preoperative mean of 3.5 ± 0.7 to a 6‐month postoperative mean of 0.3 ± 0.7 (P < 0.001) in the study group and from 3.7 ± 0.4 to 0.5 ± 1.1 (P < 0.001) in the control group. No statistically significant differences between the two groups were observed in terms of postoperative complications. Conclusion: In this pilot study it appears that trabeculectomy with OloGen does not seem to offer any significant advantages compared with trabeculectomy alone. Additionally, even though there were no statistical differences between the two groups as far as complications were concerned, one eye from the study group developed endophthalmitis 10 days after surgery and two eyes presented with positive Seidel test and flat anterior chamber and required additional suturing. Studies with larger numbers of patients and longer follow‐ups are required to confirm these findings and to examine the safety and long‐term outcomes of trabeculectomy with OloGen.     

Trabeculectomy with Ex-PRESS implant versus Ahmed glaucoma valve implantation-a comparative study

AIM: To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve (AGV) implantation. METHODS: Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation separately were included in this retrospective chart review. Main outcome measures were surgical failure and complications. Failure was defined as intraocular pressure (IOP) >21 mm Hg or <5 mm Hg on two consecutive visits after 3mo, reoperation for glaucoma, or loss of light perception. Eyes that had not failed were considered as complete success if they did not required supplemental medical therapy. RESULTS: A total of 64 eyes from 57 patients were included: 31 eyes in the Ex-PRESS group and 33 eyes in the AGV group. The mean follow-up time was 2.6±1.1y and 3.3±1.6y, respectively. Patients in the AGV group had significantly higher baseline mean IOP (P=0.005), lower baseline mean visual acuity (VA) (P=0.02), and higher proportion of patients with history of previous trabeculectomy (P<0.0001). Crude failure rates were 16.1%, n=5/31 in the Ex-PRESS group and 24.2%, n=8/33 in the AGV group. The cumulative proportion of failure was similar between the groups, P=0.696. The proportion of eyes that experienced postoperative complications was 32.3% in the Ex-PRESS group and 60.1% in the AGV group (P=0.0229). CONCLUSION: Trabeculectomy with Ex-PRESS implant and AGV implantation had comparable failure rates. The AGV group had more post-operative complications, but also included more complex cases with higher baseline mean IOP, worse baseline mean VA, and more previous glaucoma surgeries. Therefore, the results are limited to the cohort included in this study.