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目的评价现代改良复合式小梁切除术治疗晚期青光眼的临床疗效。方法对54例(69眼)晚期青光眼施行了现代改良复合式小梁切除术,即术中一次性应用MMC湿敷巩膜床;小梁切除前行前房穿刺降低眼内压,术毕由此穿刺口注液恢复前房;巩膜瓣相对牢固缝合和外置可拆除缝线。术后观察前房深度、滤过泡、视力、眼压、视野及并发症等情况,于术后2～21 d控制性定量拆除外置巩膜瓣缝线并结合滤过泡旁指压按摩,6～7 d拆除结膜缝线,随访3～12月。结果术后第1天54例(69眼)均形成前房,随访3～12月,68眼(占98.55%)形成功能性滤过泡;1眼(占1.45%)形成Ⅲ型瘢痕滤过泡。69眼(占100%)眼压在正常范围;52眼(占75.36%)术后视力与术前相同;11眼(占15.94%)术后视力较术前提高1～2行;6眼(占8.70%)因术后白内障加重视力低于术前。69眼术后未能全部进行视野检查,随访6月时有17眼(占24.64%)主观感觉视野较术前略有扩大,21眼(占30.43%)进行了全电脑视野检查确定视野较术前扩大5～10度。无术后视力丧失病例发生,未出现脉络膜出血、恶性青光眼等严重并发症。结论现代改良复合式小梁切除术治疗晚期青光眼是安全有效的,其术后降压效果较好且稳定,能避免视功能的进一步损害,减少并发症的发生,提高了抗青光眼手术的远期成功率。
Objective To evaluate the clinical efficacy of modern modified composite trabeculectomy in the treatment of advanced glaucoma. Methods Fifty-four patients (69 eyes) with advanced glaucoma underwent modern modified composite trabeculectomy, that is, a one-time application of MMC wet dressing scleral bed; trabeculectomy anterior chamber puncture to reduce intraocular pressure, the completion of surgery Puncture port injection fluid recovery anterior chamber; scleral flap relatively solid suture and external removable suture. Postoperative observation of anterior chamber depth, filtration bleb, visual acuity, intraocular pressure, visual field and complications, the control quantitatively removed the external scleral suture at 2 ~ 21 d postoperative combined with peristalsis acupoint acupressure massage, 6 ~ 7 d remove conjunctival suture, followed up for 3 to 12 months. Results The anterior chamber was formed in 54 cases (69 eyes) on the first postoperative day. Fourteen eyes (98.55%) were followed up for 3 ~ 12 months and functional filtration bleb was formed. One eye (1.45%) formed type Ⅲ scar filtration bubble. 69 eyes (100%) had intraocular pressure in the normal range; 52 eyes (75.36%) had the same postoperative visual acuity as preoperative; 11 eyes (15.94%) had 1 ~ Accounting for 8.70%) due to postoperative cataract worse vision than preoperative. Sixty-nine eyes were unable to complete visual field examination after operation, 17 eyes (24.64%) had a slight increase in subjective visual field at 6 months follow-up, and 21 eyes (30.43%) had full computer vision examination to confirm the visual field Before the expansion of 5 to 10 degrees. No cases of postoperative loss of vision occurred, no choroidal hemorrhage, severe complications such as malignant glaucoma. Conclusions Modern modified composite trabeculectomy is safe and effective in the treatment of advanced glaucoma. The postoperative antihypertensive effect is good and stable, which can avoid the further impairment of visual function, reduce the incidence of complications and improve the long-term anti-glaucoma surgery Success rate.