【摘要】目的:探讨应用复合式小梁切除术治疗慢性闭角型青光眼术后并发症的预防。方法：总结我院眼科200701/200801应用复合式小梁切除术治疗慢性闭角型青光眼有晶状体眼(198例)的术后并发症情况。结果：低眼压性浅前房发生3例,高眼压性浅前房1例,术后低眼压2例,术后眼压药物控制不良需二次手术1例。结论：复合式小梁切除手术是治疗慢性闭角型青光眼的经典手术,不需要特殊设备,不需要特殊技术,但是需要极其精细轻柔的操作,抗代谢药物恰到好处的应用,可降低各种并发症的发生。
【关键词】 复合式小梁切除术 并发症 慢性闭角型青光眼
Analysis of the clinical complications of compound trabeculectomy
XiaoHong Xu, ZhiLan Yuan, Yan Yu, JiangDong Ji
Department of Ophthalmology, Jiangsu Provincial Peoples Hospital, Nanjing 210029, Jiangsu Province, China
Abstract
AIM: To discuss the clinical complications of compound trabeculectomy on chronic angleclosure glaucoma.
METHODS: Totally 198 cases with chronic angleclosure glaucoma combined with phakic eye received compound trabeculectomy in our hospital from January, 2007 to January, 2008. The clinical complications were retrospectively studied.
RESULTS: The complication caused by the unsuccessful operation included Hypotony and flat anterior chamber on 3 cases, elevated intraocular pressure and flat anterior chamber on 1 case, low intraocular pressure on 2 cases, elevated intraocular pressure and need second surgery on 1 case.
CONCLUSION: Characterized by simple, safe, highly effective, and easy to master, compound trabeculectomy is an ideal therapy for chronic angleclosure glaucoma. Careful operation and corrected administration of MMC can decrease most kinds of surgery complications.
KEYWORDS: compound trabeculectomy; complication; chronic angleclosure glaucoma
0引言
青光眼小梁切除术因手术效果肯定,操作简单,无需特殊设备及器械,一直以来被视为治疗闭角型青光眼的经典手术。近年来抗代谢药物在术中的应用,手术方式的改良明显提高了手术成功率,降低了术后并发症。200701/200801我院用复合式小梁切除术治疗慢性闭角型青光眼共198例(212眼) ,效果良好,现将术后并发症分析报告如下。
1对象和方法
1.1对象 施行术中使用丝裂霉素的复合式小梁切除术共198例( 212眼)。诊断为慢性闭角型青光眼有晶状体眼，男88例,女110例。年龄24～88（平均55）岁。其中合并糖尿病患者38例。患者术前远视力最差者为颞侧10cm 指数, 最好者为0.8。眼压最低25mmHg,最高67mmHg。
1.2方法 在ZEISS手术显微镜下,采用苏州医疗显微手术器械行复合式小梁切除术。术中使用抗代谢药物为丝裂霉素C,浓度为0.4g/L。术前倍诺喜表麻液滴术眼2次做表麻,为避免球后阻滞麻醉可能造成的视功能损害, 病例均采用球周浸润麻醉。以前房注射针注入20g/L利多卡因与7.5g/L 布比卡因等量混合溶液1.5ml做球结膜下浸润麻醉,于12∶00方位距角膜缘1mm处做深层角膜牵引缝线,以固定眼球,沿角膜缘弧形切开90°,做以穹窿部为基底的球结膜瓣,水下电凝烧灼止血。以 12∶00方位为中心作以角巩缘为基底4mm×5mm 矩形、2/5巩膜厚度的巩膜瓣, 前达透明角膜缘前1.0～1.5mm,0.4g/L裂霉素C浸润棉片置于球结膜瓣及巩膜瓣下5min, 250mL林格氏充分冲洗敷药区域。颞侧角膜缘1mm处15°穿刺刀做侧切口,维持前房深度。于巩膜瓣下做长2mm内切口入前房,剪除小梁组织1mm×3mm,做虹膜根切,平复巩膜瓣,100尼龙线缝合巩膜瓣2针,100薇乔缝线缝合球结膜瓣数针。术毕常规抗菌消炎, 单眼垫遮盖。术后予典必舒或帕利百眼药水点眼, 2～3次/d,美多丽点眼调节瞳孔。
2结果
低眼压性浅前房发生,术后3例(1.5%)，Ⅰ级浅前房1例,Ⅱ级浅前房2例,Ⅲ级浅前房0例,其中Ⅰ级浅前房患者术后早期滤过过畅,眼压<10mmHg,滤过泡低平,予以典必殊,美多丽滴眼,垫压等治疗后,4d后前房加深,眼压恢复正常。Ⅱ级浅前房均有脉络膜脱离,予以地塞米松10mg静滴等保守治疗,于6d后恢复,前房加深,眼压恢复正常。术后低眼压2例(1%)，术后2例出现术后低眼压,黄斑水肿,滤过泡过强,1例发现滤过泡有裂孔,予以缝合,眼压恢复,另1例予以房水抑制剂口服,3d后眼压正常。术后眼压药物控制不良需二次手术1例(1%):术后1wk术眼眼压至27mmHg,予以美开朗,阿法根,派立明治疗后降至25mmHg ,于6mo后行二次小梁切除术,术后眼压控制在14mmHg左右。
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