三种抗青光眼手术对青光眼患者术后生活质量的影响

目的:探讨并比较传统小梁切除术、丝裂霉素C(MMC)小梁切除术与巩膜池小梁切除术对青光眼患者术后生活质量的影响。方法:将60例60眼接受手术治疗的青光眼患者随机平均分为A组、B组与C组。A组20例20眼患者接受传统小梁切除术治疗;B组20例20眼患者接受MMC小梁切除术治疗;C组20例20眼患者则接受巩膜池小梁切除术治疗。在术后1a对患者进行随访,观察并比较各组患者中文版低视力者生存质量量表(CLVQOL)及自我生活质量量表各分项及总分。结果:与A组相比,B组及C组CLVQOL各分项及总分均显著升高(P<0.05),C组在总分及两项分项得分("远视力、移动及光感"以及"阅读及精细工作")改善比B组更为显著(P<0.05);与A组相比,B组及C组自我评价量表总平均分及各分项得分均显著升高(P<0.05),其中C组在总平均分及两项分项得分("视力自我评分"及"主观亮度评分")改善更为显著(P<0.05)。结论:巩膜池小梁切除术对青光眼患者术后生活质量改善较明显,显著优于传统小梁切除术及MMC小梁切除术。     

改良垂直式小梁切除术与传统小梁切除术比较

目的 探讨改良垂直式小梁切除术与传统小梁切除术对治疗青光眼疗效的差异。方法 Ⅰ组采用改良垂直式小梁切除术６０例６６眼,Ⅱ组采用传统小梁切除术作对照组４５例４９眼,随访观察３－８周。结果 Ⅰ组术后眼压控制及功能性滤过泡均比Ⅱ组佳。术后并发症比Ⅱ组明显减少。结论改良垂直式小梁切除术操作简便,创伤小,降压效果稳定可靠,是治疗青光眼较好的手术方法。     

小梁切除术与联合小梁切除术的临床疗效比较

目的 比较单纯小梁切除术与联合切除术的成功率及并发症。方法 ８４例原发性青光眼随 成３组，第１组行单纯小梁切除术；第２组行小梁切除联合可拆缝线术；第３组行小梁切除术中联合丝裂霉素。术后平均随访时间为１８．４月。结果 手术成功率分别为：单纯小梁切除组，可拆除缝线组，丝裂霉素组。     

Quantitative trabeculectomy

The outcomes of the trabeculectomy which finally establish one normal ocular pressure are presented. The surgery method is adjustment of the thickness of the sclera, fragment depending on the initial ocular pressure. The evacuation of the aqueous humor after trabeculectomy is indirect proportionally with the thickness of the scleral fragment. The method was used in 36 eyes with different patterns of glaucoma. At this patients the initial ocular pressure was until 50 mm Hg. In 72.2% from cases was necessary only one surgery intervention for maintain the ocular pressure, without auxiliary drugs; two eyes underwent still one surgical intervention and in seven eyes was necessary auxiliary hypotensor drugs. The outcomes were good in 97.2% from cases. One failure was obtained in one eye with closed angle glaucoma where the trabeculectomy was complicated with malignant glaucoma. Complications were hypema, atalamy with or without choroidal detachment and high ocular pressure. All complications were improved after conservative treatment excepting the case with malignant glaucoma.     

定量滤过性小梁切除术

目的：探讨定量滤过性小梁切除术的方法及疗效。方法：将145例（180只眼）原发性青光眼随机分为A、B、C组，每组均为60只眼，A组行小梁切除联合调整缝线；B组行小梁切除联合MMC；C组行小梁切除联合MMC及调整缝线，观察术后眼压，视力，滤过泡，眼底等。结果：随访1年，手术成功率A组为81．7％，B组为93．3％，C组为96．7％，B、C两组与A组对比有显著差异。低眼压，浅前房，脉络膜脱离，黄斑水肿，视力下降等并发症，A、C两组较B组显著减少，结论：C组方法既能抑制瘢痕化又可避免术后早期超滤过引起的并发症，可定量改善滤过。     

青光眼滤过手术失败后复合式小梁切除术的疗效分析

目的探讨青光眼滤过手术失败后行复合式小梁切除术的治疗效果。方法采用复合式小梁切除术对青光眼小梁切除术失败的40例（58眼）进行再次手术（复合式小梁切除术）治疗。术后随访16-26月。结果手术前平均眼压为（36.62±9.02）mmHg,术后眼压平均为（10.21±4.12）mmHg。治疗前后平均眼压的差异有统计学意义（P〈0.05）。再次手术51眼（87.93%）获得成功。52眼（89.66%）为功能性滤泡。结论青光眼滤过手术失败后采用复合式小梁切除术进行治疗效果良好。     

单纯小梁切除与复合性小梁切除治疗青光眼的临床效果观察

目的 观察单纯小梁切除与复合性小梁切除治疗青光眼的临床效果差异.方法 将临床确诊为原发性青光眼来我院眼科行手术治疗的住院患者分为单纯小梁切除组和复合性小梁切除组,比较两组患眼的眼压、浅前房形成率、治疗后滤过泡形成情况和总体有效率的差异.结果 两组患眼手术前、手术后第5天的眼压差异无统计学意义(P＞0.05);而1个月后随访时,两组之间的差异具有统计学意义(P＜0.01).单纯小梁切除术组的浅前房形成率要显著高于复合式小梁切除术组(P＜0.05).单纯小梁切除术组非功能性滤过泡(Ⅲ、Ⅳ级)形成率为35.09％,复合式小梁切除术组非功能性滤过泡形成率8.47％,两组之间的差异具有统计学意义(P＜0.05).采用单纯小梁切除术的患者的总体有效率为77.19％,采用复合式小梁切除术的患者的总体有效率为96.61％,两组之间的差异有统计学意义(P＜0.01).结论 复合式小梁切除术有效减少术后浅前房的发生,在控制远期眼压和功能性滤过泡形成方面疗效显著,提高了手术成功率,值得临床推广.     

Outcome of trabeculectomy in hospital Melaka, Malaysia

AIM: To study the success and outcome of trabeculectomy in Hospital Melaka. METHODS: Medical records of all patients who underwent trabeculectomy between January 1, 2007 and October 31, 2010 whom were followed up for at least 6 months postoperatively in Hospital Melaka were retrospectively reviewed. RESULTS: A total number of 117 eyes of 91 patients with the age range between 12 to 84 years underwent primary trabeculectomy (n=20, 17.1%), combine trabeculectomy with cataract surgery (n=90, 76.9%), repeat trabeculectomy (n=5, 4.3%), and combine repeat trabeculectomy with cataract surgery (n=2, 1.7%). The disease spectrum includes primary open-angle glaucoma (POAG) (54 patients, 59.3%), priamry angle-closure glaucoma (PACG) (14 patients, 15.4%), secondary glaucomas (19 patients, 20.9%) and juvenile glaucomas (4 patients, 4.4%). Preoperative mean intraocular pressure (IOP) was (24.69±8.67)mmHg as compared to postoperative mean IOP of (15.81±6.66)mmHg, (15.07±4.72)mmHg and (15.68 ±3.65)mmHg at 6-month, 12-month and 24-month respectively. Eighty-two point one percent of eyes (n=96) achieved complete success (CS), 12.8% (n=15) with qualified success (QS) and only 5.1% (n=6) failed at 6 month with two of them warrant other filtering surgery. At twelve months, trabeculectomy with CS was 71.6% (n=63), QS in 22.7% (n=20) and failure in 5.7% (n=5). Sixty-seven point five percent (n=27) attained CS, 20.0% (n=8) with QS while 12.5% (n=5) failed at 24 month postoperative. CONCLUSION: As the understanding of the lower the IOP, the better the patients retaining the visual function, trabeculectomy is significantly a choice of treatment in uncontrolled glaucoma. This study concluded that trabeculectomy performed in Hospital Melaka has produced significant success as compared to other studies.     

Outcome of trabeculectomy in hospital Melaka, Malaysia

AIM: To study the success and outcome of trabeculectomy in Hospital Melaka. METHODS: Medical records of all patients who underwent trabeculectomy between January 1, 2007 and October 31, 2010 whom were followed up for at least 6 months postoperatively in Hospital Melaka were retrospectively reviewed. RESULTS: A total number of 117 eyes of 91 patients with the age range between 12 to 84 years underwent primary trabeculectomy (n=20, 17.1%), combine trabeculectomy with cataract surgery (n=90, 76.9%), repeat trabeculectomy (n=5, 4.3%), and combine repeat trabeculectomy with cataract surgery (n=2, 1.7%). The disease spectrum includes primary open-angle glaucoma (POAG) (54 patients, 59.3%), priamry angle-closure glaucoma (PACG) (14 patients, 15.4%), secondary glaucomas (19 patients, 20.9%) and juvenile glaucomas (4 patients, 4.4%). Preoperative mean intraocular pressure (IOP) was (24.69±8.67)mmHg as compared to postoperative mean IOP of (15.81±6.66)mmHg, (15.07±4.72)mmHg and (15.68 ±3.65)mmHg at 6-month, 12-month and 24-month respectively. Eighty-two point one percent of eyes (n=96) achieved complete success (CS), 12.8% (n=15) with qualified success (QS) and only 5.1% (n=6) failed at 6 month with two of them warrant other filtering surgery. At twelve months, trabeculectomy with CS was 71.6% (n=63), QS in 22.7% (n=20) and failure in 5.7% (n=5). Sixty-seven point five percent (n=27) attained CS, 20.0% (n=8) with QS while 12.5% (n=5) failed at 24 month postoperative. CONCLUSION: As the understanding of the lower the IOP, the better the patients retaining the visual function, trabeculectomy is significantly a choice of treatment in uncontrolled glaucoma. This study concluded that trabeculectomy performed in Hospital Melaka has produced significant success as compared to other studies.     

Partial external trabeculectomy

The authors show that with the Excimer laser partial trabeculectomy can be performed, a procedure in which the juxtacanalicular meshwork is removed while the other layers remain untouched. It was proved in experiments on ten enucleated human eyes that at most 3% of the outflow resistance is localized in the uveal and sclerocorneal meshwork. The clinical applicability of partial trabeculectomy was demonstrated on five eyes.     

改良小梁切除与传统小梁切除的远期效果观察

目的评价小梁切除术中改良巩膜瓣、睫状突定量小梁切除、不同缝合方式在术中术后的优缺点及远期效果。方法120例(156眼)原发性青光眼随机分为4组:A组(传统术式组)30例(42眼);B组(可拆褥式缝线组)30例(40眼);C组(L形巩膜瓣小梁切除组)30例(34眼);D组(小切口睫状突定量小梁切除术组)30例(40眼),B,C,D组为改良术式组。比较各组术后浅前房、眼压和滤过泡情况。结果浅前房发生率:A组26.19%(11/42),B组7.50%(3/40),C组2.94%(1/34),D组2.50%(1/40),改良术式组与传统术式组比较差异有统计学意义(P<0.01);随诊眼压:A组(14.65±4.30)mmHg,B组(13.87±3.60)mmHg,C组(15.58±3.20)mmHg,D组(14.50±3.15)mmHg,4组间差异无统计学意义(P>0.05);随诊功能性滤过泡A组76.19%(32/42),B组92.50%(37/40),C组97.05%(33/34),D组95.00%(38/40),传统小梁切除组与改良小梁切除组比较差异有统计学意义(P<0.05)。结论采用巩膜瓣可拆褥式缝线、L形巩膜瓣小梁切除、小切口睫状突定量小梁切除可大大降低术后浅前房的发生率,并能理想地控制眼压,提高术后视功能。     

Quantitative trabeculectomy.

The technique and results of a trabeculectomy are presented where the desired final intraocular pressure (IOP) is obtained by means of adjusting the thickness of sclerocorneal tissue removed to the initial pressure. The procedure was used in 35 eyes with all types of glaucoma and pre-operative pressures of up to 50 mmHg. In 78.3% of cases one operation was sufficient to control the IOP without additional medication. Two eyes had to be reoperated on, and 7 more needed additional pressure-lowering medication. The overall success rate, therefore, rose to 97.3%. The only failure occurred in an eye with irreducible acute angle-closure glaucoma where malignant glaucoma complicated the trabeculectomy. Complications included hyphaema (3), shallow anterior chamber (7)--with or without choroidal detachment--and transient rise in the IOP. All complications subsided with conservative therapy.