摘要
目的 观察非穿透小梁手术联合透明质酸生物胶植入术治疗开角型青光眼的临床效果 ,探讨手术失败原因和再次手术部位的选择。方法 对 13例 ( 13只眼 )非穿透小梁手术联合透明质酸生物胶植入术失败且药物控制眼压不佳的开角型青光眼患者 ,行滤过道再通术。再次手术前行超声生物显微镜 (ultrsoundbiomicroscopy ,UBM)检查 ,观察房水外流阻力发生部位 ,并予以解除 ;术中局部应用丝裂霉素 ;术后定期随访眼压。结果 UBM检查发现非穿透小梁手术联合透明质酸生物胶植入术失败后 ,虽然滤过泡实性变 ,但浅层巩膜瓣下仍有液腔存在。其中 9例因结膜瓣及浅层巩膜瓣瘢痕化造成房水外流受阻 ,深层巩膜床无明显瘢痕 ;3例非穿透小梁网表面增殖膜形成 ,其中 1例原非穿透小梁手术区范围过窄 ;1例原非穿透小梁手术处有微穿孔 ,虹膜根部与小梁相贴。再通术后随访6～ 2 4个月 ,平均 ( 14 0± 5 8)个月。随访期末 ,10例不用任何降眼压药物 ,眼压 <2 1mmHg( 1mmHg=0 133kPa) ,平均 ( 14 1± 3 7)mmHg;1例局部应用降眼压药 ,眼压控制在 15mmHg左右 ;2例再通术后 6个月手术失败 ,最终改行小梁切除术。 2例出现术后并发症 ,其中 1例前房积血 2mm ,术后 5d吸收 ;1例撕除增殖膜时 ,小梁穿孔 ,再行小的虹膜根部切除。结论 结膜瓣?
Objective Tostudythefailurecausesofnon penetratingtrabecularsurgery (NPTS)with SKGeL (ahyaluronicacidbiologicalgel)implantandthesurgicalmethodofreoperation Methods Repeated operationwithmitomycin (MMC)throughtheinitialsurgicalsitewasperformedon 13failurecases ( 13eyes)that hadundergoneNPTSwithSKGeLimplant Theblockageoffiltrationtractwasremovedandtheanteriorchamber wasintactduringthesurgery Allofthesecaseswereopen angleglaucoma Beforetherepeatedsurgeryultrasound biomicroscopic (UBM)examinationwasperformedontheprimaryfilteringbleb ,andtheintraocularpressure (IOP)examinationwasfollowedaftertherepeatedoperation Results Themeanfollow upperiodwas ( 14 0 ± 5 8)months( 6to 2 4months) TheexaminationofUBMshowedthatthefilteringblebdisappearedandtherewas aliquidchamberunderthesuperficialscleralflapineveryfailurecase Thefiltrationfailureduetothescarringat conjunctiva Tenon′scapsule superficialscleralflapinterfacein 9cases,proliferativemembraneformationonthe trabecularsurfacein 3cases,micro penertrationofthetrabeculain 1case Attheendoffollow up ,theIOPof 10 caseswaslowerthan 2 1mmHgwithoutmedication ,themeanIOPlevelwas ( 14 1± 3 7)mmHg,theIOPof 1 caseswas 15mmHgwithBetagen ,another 2casesfailedagain 6monthsaftertherepeatedsurgeryandunderwent thetrabeculectomyatlast Thecomplicationsincludedhyphemainonecaseandmicro penetrationofthetabecula inonecase Conclusions Thescarringatconjunctiva Tenon′scapsule superficialscleralflapinterfacewasthe mostimportantcauseofNPTSwithSKGeLimplantfailure ArepeatedsurgerywithMMCthroughtheinitial surgicalsitemaybeachoiceforthefailurecases
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2003年第2期87-90,共4页
Chinese Journal of Ophthalmology
关键词
非穿透小梁手术
胶体类
治疗失败
再手术
青光眼
Non- penetrating trabecular surgery
Colloids
Treatment failure
Reoperation
