薄壁囊状滤过泡的结膜瓣加固术

目的　探讨改良转移结膜瓣对矫正青光眼小梁切除术后薄壁囊状滤过泡的临床效果。方法　剪开滤过泡周围的结膜（保留原滤过泡）,游离转移上方或颞侧球结膜-筋膜组织,加固覆盖于经局部冷冻的变性囊状泡表面,转移结膜瓣的前缘固定缝合于周边角膜的槽状浅沟内。转移结膜瓣不够松弛时,在穹窿部做一减张性球结膜-筋膜组织切开。结果　46例（52只眼）术后随访6个月至4年,平均眼压由术前（4.25±1.33）mmHg（1mmHg=0.133kPa）提高至术后（12.98±5.70）mmHg,差异有显著性（t=3.26,P<0.01）。51只眼仍保留滤过功能,20只眼的结膜渗漏和6只眼的黄斑水肿消失,术后视力较术前有明显改善（χ

Revision of thin-walled cystic bleb by transposing conjunctival flap technique

OBJECTIVE: To investigate the clinical effect of transposing conjunctival flap technique on thin-walled cystic blebs after trabeculectomy for treatment of glaucoma. METHODS: Fifty-two eyes of 46 patients with thin-walled cytic blebs were underwent this modified operation. The procedure involved incising the conjunctiva surrounding the preserved bleb, then the conjunctiva-Tenon's fascia flap superior or temporal to the cystic bleb was relaxed and mobilized to cover the bleb surface after topical cryopexy. The anterior margin of the flap was sutured onto the peripheral cornea. In order to relax the conjunctival flap sufficiently, an incision was made close to the superior fornix above the flap and parallel to limbus to decrease the tension. RESULTS: In the follow-up of 6 months-4 years, the mean intraocular pressure (IOP) of 52 eyes increased to postoperative (12.98 plus minus 5.70) mm Hg from preoperative (4.25 plus minus 1.33) mm Hg (1 mm Hg = 0.133 kPa) (t = 3.26, P < 0.01), 51 eyes maintained the filtering function. Post-operatively, the bleb leakage in 20 eyes and macular edema in 6 eyes disappeared. Local antiglaucoma medication was required in one eye, because the bleb disappeared with increasing IOP. The post-operative visual acuities were elevated in comparison with that before the operation (chi(2) = 16.65, P < 0.01). CONCLUSION: The transposing conjunctival flap technique is an effective surgery for the repair of thin-walled cystic bleb whose complications, such as hypotony, maculopathy, bleb leakage or endophthalmitis can be cured or prevented.