【摘要】 目的　观察复合式小梁切除术治疗难治性青光眼及原发性青光眼的疗效。方法　对 1998年 7月至2 0 0 0年 5月收治的难治性青光眼、晚期原发性开角型青光眼、前房极浅或疑有恶性青光眼倾向的原发性闭角型青光眼 38例 (38只眼 )进行复合式小梁切除术。术后根据眼压水平、滤过泡形态及前房情况适时拆除巩膜瓣缝线。定期随访患者平均 14± 2 .9个月。内容包括 :眼压、视力、滤过泡、前房、晶状体及眼底。结果　 6只眼术后因眼压控制良好未作缝线拆除 ;32只眼分别于术后 3～ 31天拆线 ,拆线时间平均 12 .1± 7.9天 ,拆线后眼压平均下降 10 .1± 5 .4 m m Hg。患者术后一周平均眼压 13.7± 5 .9mm Hg,与术前平均眼压 2 6 .6± 10 .1mm Hg相比 ,差异有非常显著性。术后 12个月末时眼压≤ 2 1m m Hg者 32只眼 (84 .2 % ) ,其中 2 8只眼眼压≤ 15 m m Hg。 12个月末时功能性滤过泡的累积存活率为 80 .1± 5 .4 %。术后 33只眼呈中度或深前房 ;4只眼术后第一天前房浅 度 ,经药物治疗前房逐渐加深 ;1只眼因伴发脉络膜脱离发生 度浅前房。并发症有前房积血 4只眼 ,脉络膜脱离 1只眼 ,无血管的薄壁微囊样滤过泡 1只眼 ,持续性低眼压 2只眼 ,低眼压性黄斑病变 1只眼。结论　复合式小梁切除术既可避免术后早期滤过过强?更多还原

【Abstract】 Objective To evaluate the efficacy of combined therapy with using Mitomycin C intratrabeculectomy and suture lysis following trabeculectomy(CTMTL).Methods From July of 1998 to May of 2000,CTMTL was performed for 38 eyes of 38 cases with refractory,advanced primary open angle glucoma,primary close angle glaucoma with very shallow chamber or malignant glaucoma suspect.Postoperatively,accoring of the IOP,bleb appearance,and the anterior chamber deepth(ACD),the scleral flap sutures were loosened or removed.The mean period of postoperative follow-up was 14±2.9 months.Postoperatively,the intraocular pressure(IOP),ACD,the visual acuity,the bleb appearance,the lens and fundus were observed and recorded.Results The scleral flap sutures of 32 eyes were loosened or removed in the postoperative 3 to 31 days.After removing sutures,The mean IOP was reduced by 10.1±5.4mmHg.The mean IOP was 26.6±10.1mmHg preoperatively and 13.7±5.9mmHg in one week after surgery,the difference being significant.On the 12 th month,the IO was≤21mmHg in 32 eyes(84.2%),and among them,the IOP was ≤15mmHg in 28 eyes.The 12th month life table cumulative success of functional bleb formation was 80.1±5.4%.Postoperatively,moderate or deep anterior chamber developed in 33 eyes.On the first postoperative day,there was Ⅰ°flap anterior chamber in 4 eyes,there was Ⅲ° flap anterior chamber related to choroid detachment in one eye.The complications included hyphema,choroid detachment,avascular thin walled microcystic bleb,persistent hypotention,hypotonous maculopathy.Conclusion CTMTL can reduce effectively the incidence of the complications related to the over filtration after trabeculectomy early,it also can be effective in reducing scar formation,therefore,increaing the efficacy of anti glaucoma surgery greatly.更多还原