作者:张胜利,赵俊宏 作者单位:714000)中国陕西省渭南市第一医院眼科;(710002)中国陕西省西安市第一医院眼科;(710061)中国陕西省西安市,西安交通大学医学院解剖与组织胚胎系
【摘要】 目的:探讨巩膜隧道加非缝合巩膜瓣的滤过手术治疗急性闭角型青光眼的临床效果。 【关键词】 急性闭角型青光眼;滤过手术;治疗;非缝合
Scleral tunnel and non suture scleral flag filtration surgery in treating acute angleclosure glaucoma ShengLi Zhang, JunHong Zhao Department of phthalmology, Weinan No.1 Hospital, Weinan 714000, Shaanxi Province, China;Department of Ophthalmology, Xian No.1 Hospital, Xian 710002, Shaanxi Province, China; Department of Anatomy and Histology and Embryology, Medical College of Xian Jiaotong University, Xian 710061, Shaanxi Province, China Abstract
AIM: To study the clinical effects of scleral tunnel and non suture scleral filtration surgery in treating acute angleclosure glaucoma(AACG). METHODS: This retrospective study included the clinical data of 46 cases (46 eyes) AACG patients, who were in our hospital from January 2004 to December 2007. We compared the visual acuity (VA), intraocular pressure (IOP), visual field and complications before and after surgery.
RESULTS: Surgeriyes were smoothly operated on 46 cases, they were followed up for 48 months after surgery, the mean IOP was 15.3±4.87mmHg and 16.8±4.77mmHg 1 and 5 months respectively after sugery. There were statistical differences before and after surgery (P<0.01). One week after surgery, the anterior chamber was stable, 8 cases had mild uveitis and the VA was not decreased compared with preoperation, the visual field was reexamined without obvious changes.
CONCLUSION: Scleral tunnel and non suture scleral flag filtration surgery, which can effectively decrease IOP in treating AACG and with less complication, is an effective filtration surgery methods.
KEYWORDS: acute angleclosure glaucoma; filtration surgery; treatment; non suture
方法:回顾性分析200401/200712收治于我院的46例46眼急性闭角型青光眼患者临床资料,比较手术前后视力、眼压、视野、并发症等。
结果:所收46例患者均顺利完成手术,术后随访4~8(平均5.21±4.12)mo,术后1mo平均眼压15.3±4.87mmHg,术后5mo平均眼压16.8±4.77mmHg , 经统计学处理,手术前后眼压有统计学差异(P<0.01)。术后1wk前房稳定,8例有较轻的葡萄膜炎反应, 术后5mo视力较术前无下降,视野复查未见明显改变。
结论:巩膜隧道加非缝合巩膜瓣的滤过手术治疗急性闭角型青光眼可以有效降低眼压, 手术并发症少,是一种有效的滤过手术方式。
0引言
青光眼是一组以视神经凹陷性萎缩和相应的视野缺损为共同特征的疾病,病理性眼压升高是其主要危险因素[1]。急性闭角型青光眼是一种以眼压急剧升高并伴有相应症状和眼前段组织改变为特征的眼病。致盲率极高,如治疗不及时,严重者数天内失明,处理不当也受影响,应积极救治,在最短的时间内降低眼压,尽可能避免永久性周边虹膜前粘连产生,挽救患者的视功能。目前眼科医师常采用常规小梁切除术或者巩膜瓣下巩膜咬切手术,手术中缝合巩膜瓣2~4针,可有效降低眼压,但是也有不少并发症,增加了患者的心理及经济负担[2]。我们采用了巩膜隧道加非缝合巩膜瓣的滤过手术治疗急性闭角型青光眼,取得了良好效果,现报告如下。
图1 滤过道示意图,长方形ABFE表示巩膜瓣区,长方形EFCD表示巩膜隧道区(略)
表1 手术前后不同时间患者眼压变化(略)
bP<0.05 vs术前
1对象和方法
1.1对象 本组为200401/200712在我科住院的46例46眼患者资料,其中男14例,女32例。年龄49~71岁,均在我科诊断为急性闭角性青光眼。其青光眼的分期按入院时的情况进行:急性发作期31例,缓解期15例;术前视力均<0.4,房角检查为窄Ⅲ~窄Ⅳ,房角关闭>1/2圆周。若眼压高于30 mmHg,术前应用降眼压药物,包括静脉滴注甘露醇,不同类型降低眼压药物联合应用等,用药时间大约为1wk。如果是缓解期青光眼,一般观察眼压2~3d,眼压稳定在25mmHg以下可以手术治疗。
1.2方法 等量20g/L利多卡因与7.5g/L布比卡因球周麻醉;上直肌牵引缝线固定眼球,做以上穹隆为基底的10∶00~1∶00位的结膜瓣,滤过道示意图(图1)。于角膜缘11∶00~1∶00位,距角膜缘后界4mm、作小长方形巩膜瓣ABEF(2mm×4mm),深1/2巩膜厚度,然后改用隧道刀继续向角膜方向作巩膜隧道EFCD(2mm×4mm),深1/2巩膜厚度,隧道向前分离至角膜缘前界,用矛状刀切开内切口,内切口比外切口稍大。将巩膜咬切器深入巩膜隧道切口后唇,咬切1.5mm×2mm深层巩膜组织,并于该处作相应的周边虹膜切除,恢复虹膜,巩膜瓣不缝合,结膜瓣常规缝合2~4针,术眼常规包扎。检查方法:术后1wk~10d内每日检查1次,术后3wk;1,2,3,5mo各1次。检查项目包括视力、眼压、滤过泡情况、前房、眼底情况;术后1mo检查房角,5mo复查视野。
[1] [2] 下一页 |