摘要
目的 :研究非穿透性小梁切除术治疗开角型青光眼的手术效果、手术并发症及可能的降压机制。病人和方法 :男性 2 7例 ,女性 13例 ,共 40例 5 3眼。平均年龄 41.87± 2 0 .92岁。其中原发性开角型青光眼 2 4例 (32眼 )、先天性青光眼 5例 (8眼 )、皮质类固醇性青光眼 4例 (6眼 )、外伤性青光眼 7例 (7眼 )。手术在上方角巩膜缘做双层巩膜瓣 ,第二层巩膜瓣的深度为略暴露出点状葡萄膜组织 ,并向透明角膜区分离出 1～ 2 mm后弹力层 ,房水通过后弹力层渗出。剪除第二层巩膜瓣 ,手术不进入前房 ,术毕在巩膜瓣下注入透明质酸钠。术后观察病人前房反应、眼压及结膜滤枕情况。随访时间 3～ 18个月。结果 :术中 8眼穿破小梁 -后弹力膜 ,术后前房反应轻 ,6眼发生前房出血 ,1眼出现羊脂状角膜后沉淀。 17眼结膜形成滤过手术典型滤过泡 ,36眼结膜疏松 ,无滤过泡形成。各种青光眼的术后降压幅度较术前分别降低 32 .4～ 5 2 .8%。结论 :非穿透性小梁切除术能很好的降低开角型青光眼病人的眼压。因术后并发症轻、少 ,可做为门诊青光眼病人和高危青光眼病人手术的选择。
Objective:To study the effectiveness and complication of non penetrating trabeculectomy (NPT) for open angle glaucoma and to explore the mechanisms of aqueous humor outflow at this procedure.Patients and Methods:Male were 27 cases,female 13 cases,total 40 cases (53eyes).Mean age was 41 87±20 92.The patients included primary open angle glaucoma 24 cases (32) eyes,congenital glaucoma 5 cases (8eyes),corticosteroid glaucoma 4 cases (6)eyes,secondary glaucoma by contusion 7 cases (7eyes).At first we created two scleral flaps.The second flap was dissected enough deep to expose a litter choroid and went forward to 1-2mm clear cornea.Then the second flap was excised.Aqueous humor percolated from descemet membrane.At last we sutured the superficial flap and filled viscoelastic underneath the flap.We observed the anterior chamber,filter bleb and IOP after operation.All patients were followed up 3 18 months.Results:The trabeculo descemet membrane was penetrated in 8 eyes.The anterior chamber reaction was mild.There were hyphema occurred in 6 eyes after operation and 1 eye shown K P. 1 month later.17 eyes produced obvious filter blebs and the others were flat and diffusion.IOP was decreased 32.4%-52.8% than that before operation.Conclusion:NPT can lower the IOP effectively in this group of patients.There were a few complications occurred after operation.It can been choose for more dangerous open angle glaucoma patients and performed it in out patient department We infer that posterior sclera choriod aqueous humor drainage be one of mechanism for lowering IOP.
出处
《中国实用眼科杂志》
CSCD
2000年第11期690-692,共3页
Chinese Journal of Practical Ophthalmology
