改良的扇形巩膜瓣半隧道切口行复合小梁切除术治疗原发性闭角型青光眼的临床疗效

目的　探讨改良的扇形巩膜瓣半隧道切口行复合小梁切除术治疗原发性闭角型青光眼的临床疗效。方法　采用病例对照研究方法对１１８例原发性闭角型青光眼患者进行分组。对照组５８例（７６眼）采用三角形巩膜瓣的复合小梁切除术；观察组６０例（７８眼）采用改良的扇形巩膜瓣半隧道切口的复合小梁切除术。记录两组患者的临床效果、术后是否浅前房、眼压情况、滤过泡形态等。结果　术后对照组浅前房发生率为１８．４２％，观察组浅前房发生率为１．２８％，两组差异有统计学意义（χ２＝１２．８６２，Ｐ＝０．０００）。术后１周和６个月，对照组患者眼压分别为（１３．３２±４．４１）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ）和（１４．６２±３．５０） ｍｍＨｇ，观察组患者眼压分别为（１３．２９±４．０８）ｍｍＨｇ和（１４．６７±３．７１）ｍｍＨｇ；眼压随时间推移有升高趋势；两组患者眼压比较，差异无统计学意义（Ｆ＝０．００３，Ｐ＝０．９５３）。术后１个月对照组功能性滤过泡占７８．９５％，观察组功能性滤过泡占９２．３１％，两组差异有统计学意义（χ２＝５．６１１，Ｐ＝０．０１８）。结论　采用改良的扇形巩膜瓣半隧道切口行复合小梁切除术治疗原发性闭角型青光眼，操作简便，浅前房发生少，术后降压效果及滤过泡形成好，手术成功率高。

Compound trabeculectomy with modified fan-shaped scleral flap and half-tunnel incision for primary angle closure glaucoma

Objective To evaluate clinical outcomes of compound trabeculectomy with modified fan-shaped scleral flap and half-tunnel incision for primary angle closure glaucoma. Methods It was a case-control study. A total of 118 cases ( 154 eyes) with acute primary angle closure glaucoma were observed retrospectively and divided into the control group ( 58 cases,76 eyes , triangle cleral flap compound trabeculectomy) and treatment group ( 60 cases ,78 eyes , modified fan-shaped scleral flap and half-tunnel during operation) . Anterior chamber.intraocular pressure ( IOP) and filtering bleb were observed. Results After operation, the incidence of shallow anterior chamber in the control group and treatment group were 18. 42% and l. 28% , respectively , the difference was statistically significant(X2 = 12. 862 ,P = 0. 000) . IOP at postoperative I week and 6 months in the control group were ( 13. 32 +4. 41 ) mmHg and ( 14. 62 + 3. 50) mmHg ( I kPa = 7. 5 mmHg) , respectively , which in the treatment group were ( 13. 29 + 4. 08 ) mmHg and ( 14. 67 + 3. 71 ) mmHg, respectively , the difference was not statistically significant (F = 0. 003.P = 0. 953). The ratio of sustained filtering bleb at postoperative I month in the control group and treatment group was 78. 95% and 92. 31% , respectively, there were statistically significant difference between two groups (X2 = 5. 611, P = 0. 018). Coriclusion Compound trabeculectomy with modified fan-shaped scleral flap and half-tunnel incision for primary angle closure glaucoma can reduce the incidence of shallow anterior chamber. decrease IOP effectively, form functional frltering bleb and reduce the operative procedure . and it ’ s a feasible operative approach.