角膜切口小梁切除术临床分析

目的：探讨一种不易引起滤过区瘢痕组织形成、疗效稳定的治疗青光眼的手术方式。方法：对传统的小梁切除术的切口及巩膜瓣进行改良，采用角膜切口，不作球结膜瓣，巩膜瓣作成隧道式，于隧道底切穿浅层巩膜形成滤过通道。结果：术中术后并发症少；远期疗效好，经长期随访眼压正常，滤过分布广泛，滤过泡无缩窄或消失；大部分视力不同程度提高。结论：角膜切口小梁切除术是一个并发症少，成功率高，远期效果稳定的治疗青光眼手术方法。     

持续性高眼压青光眼手术治疗的临床观察

目的 观察持续性高眼压青光眼的手术疗效。方法 对２０例２２眼持续性高眼压青光眼患者采用复合式小梁切除术联合后巩膜隧道切开引流，缓慢降低眼压后完成手术。术后随访３￣１４月。结果 术后平均眼压为１４．５７ｍｍＨｇ，比术前平均眼压降低３６．０５ｍｍＨｇ，手术成功率为９１％。全部病例无严重并发症。结论 复合式小梁切除术联合后巩膜隧道切开引流降低眼压的术式，可有效地控制眼压，减少并发症，提高一次手术成功率。     

小梁切除术后白内障不同切口手术效果对比

目的 观察小梁切除术后的白内障，采取透明角膜切口及巩膜隧道切口行超声乳化吸出人工晶状体植入术的临床效果。方法 39例(40眼)施行过小梁切除术的白内障分为2组，分别行透明角膜切口(21例，22眼)和巩膜隧道切口(18例，18眼)，随访术后两组视力、眼压、角膜透明度等的变化情况。结果 术后1天-1月两组视力、眼压、角膜透明度等相比较，差异均无显著意义。结论 小梁切除术后的白内障超声乳化吸出人工晶状体植入术，透明角膜切口与巩膜隧道切口两者均可作为手术的选择。     

婴幼儿型青光眼不同术式疗效分析

对38例70眼婴幼儿型青光眼，采用单纯小梁切除术22眼，外路小梁切开术28眼，外路小梁切开朕合小梁切除术20眼．术后随访6月～4年，70眼中有56眼眼压得到控制（＜2．8kPa），角膜透明，角膜横径和杯盘比例不进展或缩小，三种手术的成功率分别为63．6％、85．7％、90％。提示，外路小梁切开联合小梁切除术疗效高，不增加病人痛苦及手术并发症，值得推广。     

经角膜的小梁切除术临床效果观察

结膜和结膜下组织的瘢痕形成是抗青光眼滤过手术失败的主要原因。经角膜的小梁切除术不同于常规小梁切除术。此手术不做结膜切口，从角膜入路潜行于板层巩膜间行部分浅层巩膜切除和小梁切除。本手术最大限度地减少了对结膜的刺激和损伤。我们对１５只眼行此手术。术后滤过泡扁平、弥散且结膜充血轻微。１４只眼在不用降眼压药情况下限压正常。     

青光眼术后颞侧巩膜小切口手法白内障摘出术

目的评价青光眼小梁切除术后经颞侧巩膜隧道小切口非超声乳化手法娩核囊外摘出术治疗白内障的手术方法和临床效果。方法对38例42眼施行手术。常规球后麻醉。于颞侧角膜缘后2.0 mm行直线形或反眉形巩膜板层切开,长为5.5 mm,作隧道切口至透明角膜内1 mm。注入黏弹剂,行连续环行撕囊或开罐式截囊,直径6 mm,水分离后以旋转法将晶状体核旋入前房,以晶状体圈匙将核托出。以注吸针头吸净晶状体皮质。囊袋内植入人工晶状体。术中缩瞳。术后随访至少3月,观察视力、眼压、滤过泡等。结果本组38例42眼术后第3天视力≥0.5者29眼(69.04%),术后眼压均在正常范围内,对原滤过泡无影响,未见严重并发症。结论青光眼术后特别是上方小梁切除术后的白内障患者,经颞侧巩膜隧道式小切口进行手法娩核白内障手术切实可行,效果良好,值得向基层医院推荐。     

信息快递

微小小梁切除术用于瘢痕严重的青光眼患者小梁切除术后眼压不能控制需要再次手术治疗 ,或白内障术后需要施行小梁切除术 ,在以往做过手术的部位进行分离 ,出血多 ,术后瘢痕增生明显 ,手术失败可能性增大。对原有的小梁切除术进行改进 ,采用微小小梁切除术技术 ,对组织损伤小 ,减轻了术后的瘢痕增生 ,提高了手术的成功率。该方法做 3ｍｍ角膜缘切口 ,距角膜缘 3ｍｍ做巩膜切口 ,深达 1/2 ,潜行分离呈巩膜囊袋状 ,3ｍｍ长 ,2ｍｍ宽。角膜缘内 1ｍｍ切入前房并咬切角巩膜组织。该方法以巩膜囊袋代替巩膜瓣 ,减少过多的分离 ,手术范围小 ,手术时…     

巩膜瓣下小梁切除术巩膜瓣缝合与否的疗效比较

1968年Cairns首先报道滤帘切除术治疗原发性青光眼获得很好疗效,其后国内有许多作者亦报道此手术疗效满意。根据Cairns和Warson等氏认为本术式成功的机理主要是手术切除了青光眼病变阻塞的小梁和一段Schlemm氏管,使房水直接从管的两断端流入管腔内经集合管和巩膜内静脉丛连接向外引流。GoLdmann和GaLin等认为滤帘切除术的降压机理主要是外引流作用。我们采用巩膜瓣下小梁切除术的巩膜瓣分为缝合与不缝合两组,作对照观察其疗效。     

改良小梁切除术

小梁切除术是1968年Cairns所提倡,1969年Watson略作修改的一种显微手术。国内对此术式已有报导。我院于1980年在无显微镜条件下,对部分青光眼患者在上述术式的基础上,进行了改良小梁切除术,治疗各类型青光眼61例72眼,手术成功率为92.2%简介如下:     

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 …     

Mini-trabeculectomy without radial incisions

PURPOSE: To describe a new modification of Cairns trabeculectomy. METHODS: Surgical adjustment includes a small, 3-mm, fornix-based conjunctival flap, a circumferential scleral incision at a distance of only 1 mm from the corneoscleral limbus, and a sclerocorneal tunnel without scleral radial incisions. RESULT: Among the various clinical and technical advantages of the procedure is the possibility of performing more operations through the superior limbus rather than reverting to an inferior trabeculectomy or implantation of an aqueous shunt. CONCLUSION: The reduced surgical area and manipulations of the current procedure appear to offer advantages over the standard approach.     

Mini-trabeculectomy in eyes with high risk of scarring: midterm follow-up

PURPOSE: To report on the surgical outcome after at least 1 year of follow-up of mini-trabeculectomy (without scleral radial incisions), which took place in eyes at high risk of postoperative filtering bleb scarring. METHODS: In a prospective, institutional study, mini-trabeculectomy was performed on 26 eyes of 26 consecutive patients aged 40 years and older who had undergone a previous intraocular surgery or had had a post-traumatic recessed anterior chamber angle. The surgical procedure, a modification of the standard trabeculectomy, involved a 3-mm fornix-based conjunctival flap, sclerostomy at 1 mm from the limbus, and a sclerocorneal tunnel without radial incisions. During surgery, 0.4 mg per ml of mitomycin C was applied in the scleral pocket of each eye for 3 minutes. Of the 26 eyes, each of two eyes underwent an intraocular intervention during the first postoperative year and therefore was evaluated only for surgical complications. Another eye underwent inferior mini-trabeculectomy, and three other eyes did not complete 12 months of follow-up. Twenty eyes have completed 12 months or more of follow-up and were included in the midterm calculations of intraocular pressure control. RESULTS: Mean preoperative intraocular pressure (n = 20) was 32.2 +/- 9.5 mm Hg with 3.3 +/- 0.9 hypotensive medications. After 12 to 37 months (mean, 22.1 +/- 6.6) of follow-up, intraocular pressure was 20 mm Hg or less in 18 of 20 eyes (90%) and the mean intraocular pressure was 17.4 +/- 2.9 mm Hg (range, 12 to 23) with 1.1 +/- 1.2 hypotensive medications (range, 0 to 4). At that time, the filtering bleb was low and fleshy in appearance in 15 eyes (75%). Postoperative complications of the 22 eyes included early postoperative aqueous leakage in one eye (4.5%); cataract extraction took place in one eye and vitrectomy was performed in another eye, 7 and 3 months postoperatively, respectively. The four eyes that were excluded from the study had controlled intraocular pressure at the last examination. CONCLUSION: Mini-trabeculectomy in eyes with high risk of scarring was found efficacious and relatively safe. The relatively small peritomy, the tunnel approach, and the avoidance of radial incisions seem to offer important advantages over the standard trabeculectomy.     

Mini-trabeculectomy as initial surgery for medically uncontrolled glaucoma

PURPOSE: To report on the surgical outcome after at least 12 months of follow-up of mini-trabeculectomy (without radial incisions) as an initial surgery. METHODS: In a prospective, institutional study, mini-trabeculectomy was performed as the initial surgical therapy on 41 eyes with medically uncontrolled glaucoma of 41 consecutive patients aged 40 years or older. Mini-trabeculectomy consists of a 3-mm fornix-based conjunctival flap, sclerostomy at 1 mm from the limbus, and a sclerocorneal tunnel without radial incisions. Of the 41 eyes, four eyes did not complete 12 months of follow-up. Of the remaining 37 eyes, one eye underwent cataract extraction 5 months postoperatively and was evaluated only for surgical complications. Thirty-six patients with a mean age of 70.3 +/- 7.4 standard deviation years (range, 54 to 87) completed 12 months or more of follow-up. RESULTS: In the 36 eyes, mean preoperative intraocular pressure was 30.2 +/- 9.3 mm Hg (range, 19 to 54) with 3.0 +/- 1.2 hypotensive medications (range, 1 to 4). After postoperative mean follow-up of 25.0 +/- 9.2 months (range, 12 to 43), intraocular pressure was at or below the planned target intraocular pressure in 35 eyes (97.2%; P <.0001) and mean intraocular pressure was 16.0 +/- 2.8 mm Hg (range, 11 to 21) with 0.8 +/- 1.0 medications (range, 0 to 3). Postoperative complications in the 37 eyes included early postoperative aqueous leakage with moderately shallow or deep anterior chamber in two eyes (5.4%) and rapid cataract progression in one eye (2.7%). The four eyes that were excluded from the study had intraocular pressures of 10 to 16 mm Hg with 0 to 1 hypotensive medications, 3 to 9 months after surgery, respectively. CONCLUSIONS: Mini-trabeculectomy, which may offer clinical and technical advantages over the standard trabeculectomy, was generally efficacious and relatively safe, based on outcome observed at a mean of 25 months follow-up. A controlled study is required to confirm these observations.     

Otago Glaucoma Surgery Outcome Study. Atypical late failure of drainage following clear cornea trabeculectomy

Background: Bleb scarring is the major cause of late drainage failure following the standard trabeculectomy. To overcome this, Cairns described a modification of his original technique, which he termed the clear cornea trabeculectomy. The essential feature was communication between the anterior chamber and subconjunctival space without intraoperative disturbance of the conjunctival or Tenon's tissue. As there is little published data on Cairns’ clear cornea trabeculectomy, this study aimed to assess the long‐term success of this procedure relative to conventional trabeculectomy. Methods: Patients who underwent clear cornea trabeculectomy at Dunedin Hospital were identified. Cases in which late failure occurred were subject to a detailed review. Records of all patients in whom late failure of drainage occurred following conventional trabeculectomy performed since 1985 were also reviewed. The nature of late drainage failure associated with these different procedures was assessed. Results: Late failure of drainage occurred in three of 21 eyes following clear cornea trabeculectomy. In each case there was an accelerated drainage failure with a dramatic rise in intraocular pressure. Consequent visual loss occurred in two patients. Late failure occurred in 32 of the 450 cases of conventional trabeculectomy, in all of which the pressure rise was gradual and less acute. Conclusions: This report highlights a previously unreported type of late failure associated with clear cornea trabeculectomy, which may result in significant visual loss. This reinforces the view that the standard Cairns’ trabeculectomy is a safer procedure.     

A comparative evaluation of astigmatic neutrality of 5 mm self-sealing tunnel incision of different types

The impact produced by incisions of 2 examined types on the corneal refraction was studied in 40 patients (40 eyes) shared between 2 groups according to an incision type. 5 mm tunnel self-sealing incisions of 2 types, i.e. temporal corneal one longer by 3 mm, and upper linear sclerocorneal one stabilized by horizontal suture, were made use of. The obtained refraction was evaluated on week 1 and then in 1 and 3 months after surgery. Group 1 (surgical approach: 5 mm linear sclerocorneal tunnel incision): the mean value of induced astigmatism made 0.68 D during the initial 3 postoperative days, 0.62 D in 1 month after surgery and 0.73 D in 3 months after surgery. Group 2 (surgical approach: 5 mm temporal corneal tunnel incision): the above value made 1.1 D during the initial 3 postoperative days, 0.7 D in one month after surgery and 0.52 D in 3 months.     

Combined phacoemulsification,pars plana vitrectomy,and foldable intraocular lens implantation

We describe a technique for combined cataract and vitreoretinal surgery using sutureless sclerocorneal and sclerotomy incisions and a foldable intraocular lens. This technique, with its variations for cases with and without gas-fluid exchange, was successfully performed in 40 consecutive cases over a 5-month period. No significant complications related to the surgical procedures were encountered. The rationale and advantages of this technique are discussed.     

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.     

Success criteria and success rates in trabeculectomy with and without intraoperative antimetabolites using intensified postoperative care (IPC)

Purpose: To define the success rate of trabeculectomy for surgical treatment of glaucoma under intensified postoperative care (IPC) conditions in cases of severe visual field damage or progression of visual field loss. Methods: In a retrospective study, we evaluated the outcome of trabeculectomy in 99 eyes of 99 patients from October 1995 to June 1997. In 23 eyes, antimetabolites were used intraoperatively. Regarding intraocular pressure (IOP), success was defined as lowering the preoperative, maximally treated IOP by more than 20% in addition to a postoperative IOP level lower than 21 mmHg without using further glaucoma medication. Success rate was defined by stabilisation of visual acuity and visual field in addition to IOP reduction. Results: The postoperative IOP was 14.7 mmHg (±3.4 mmHg) following standard trabeculectomy (preoperative IOP 24.3±6.7 mmHg) and 15.8 mmHg (±4.9 mmHg) following trabeculec-tomy with intraoperative anti- metabolites (preoperative IOP 27.0±9.5 mmHg). The success rate concerning the IOP was 83% in standard trabeculectomy and 74% following trabeculectomy with intraoperative antimetabolites. The visual acuity showed stabilisation in 93% of cases following standard trabeculectomy and in 100% following trabeculectomy with intraoperative antimetabolites. The visual field showed stabilisation according to the Aulhorn criteria in 95% and 94% of cases following standard trabeculectomy and trabeculectomy with intraoperative antimetabolites, respectively. The total success rate using all criteria together was 76% following standard trabeculectomy and 74% following trabeculectomy with intraoperative antimetabolites. Conclusion: The overall outcome after trabeculectomy is good with appropriate follow-up and timely decisions for after- treatment to ensure good development of the filtering bleb. Received: 24 June 1999 Revised: 6 January 2000 Accepted: 18 January 2000     

白内障超声乳化联合小梁切除术

目的:探讨白内障超声乳化联合小梁切除术的手术方法及临床疗效。方法:对102例102眼白内障合并青光眼的患者施行白内障超声乳化联合巩膜隧道切口内的小梁切除术。结果:术后随访2～16mo,平均眼压由术前24.82mmHg(1mmHg=0.133kPa)降到术后16.52mmHg,房水流畅系数0.38,功能性滤泡占81.5%。术后裸眼或矫正视力>0.3者79.4%。结论:对白内障合并青光眼的患者施行白内障超声乳化联合巩膜隧道切口内的小梁切除术可显著提高视力、控制眼压,建立滤过功能和避免二次手术导致的医源性损伤及减低医疗成本等。     

Surgical outcome after early intraocular pressure elevation following combined cataract extraction and trabeculectomy

BACKGROUND AND OBJECTIVES: We report on the incidence and course of early postoperative intraocular pressure (IOP) elevation and related surgical outcome following combined manual extracapsular cataract extraction (ECCE), using a sclerocorneal tunnel incision and trabeculectomy. PATIENTS AND METHODS: The combined procedure was the initial surgery in each eye. Intraocular pressure was measured during the first 4 days, at 1 week, and thereafter following surgery. RESULTS: Of 38 eyes (38 consecutive adults), postoperative IOP elevation to > 25 mm Hg was found in 7 eyes (18.4%) during the first 3 postoperative days. The IOP was reduced to < or = 20 mm Hg without hypotensive medication in 3 of them within the first 3-7 postoperative days, and remained so after 7-16 months (mean, 10.3 +/- 4.9 months). Each of the other 4 eyes underwent argon-laser suture lysis 8-10 days after surgery due to unstable IOP which rose to > 30 mm Hg. Two weeks after the operation and thereafter, ie, after 8-22 months (mean, 12.8 +/- 6.4 months), each of these 4 eyes necessitated 1-4 (mean, 2.5 +/- 1.3) hypotensive medications. CONCLUSION: This study raises the possibility that in eyes with early IOP elevation, a delay in promoting aqueous outflow beyond a critical period during the first postoperative week might become a risk factor for full surgical success.