目的:探讨在高眼压状态下行青光眼滤过手术的方法和技巧,并观察疗效。方法:选取高眼压青光眼患者50例,手术前眼压>40mmHg。行复合式小梁切除(小梁切除+虹膜周切术),提前前房穿刺减压,手术中巩膜瓣下及筋膜下使用MMC(0.2或0.4g/L),较宽的虹膜根切口,根据手术中眼压和前房形成状况选择玻璃体腔穿刺抽液,做巩膜瓣可调整缝线。结果:术后随访3mo,视力提高26例,不变24例。41例眼压<21mmHg;1例术后1wk出现浅前房,再次行前段玻璃体切除、前房成形术;1例行白内障摘出、后囊截开、前房成形术;2例2mo后行睫状体光凝;5例患者术后1mo眼压升高,联合使用1～2种降眼压药物后,眼压控制在21mmHg以下。结论:高眼压状态下行青光眼滤过手术,需要改良、细化手术的部分操作,可以提高手术成功率,挽救残存视力。

·AIM:To approach the method and skill of filtering operation for glaucoma under high intraocular pressure(IOP)and observe the curative effect.METHODS:All of 50 glaucoma patients with high IOP which was >40mmHg preoperatively.Trabeculectomy combined with peripheral iridectomy were performed in anterior chamber to decompress using MMC(0.2g/L or 0.4g/L)under scleral flap and fascia during operation.RESULTS:Followed-up for 3 months after operation,vision was improved in 26 cases,unchanged in 24 cases;IOP of 41 cases was <21mmHg;1 case received anterior vitrectomy and anterior chamber plastic operation because of occurring shallow anterior chamber at 1 week postoperatively;extraction of cataract,posterior capsule split and anterior chamber plastic operation were performed in 1 case;at 2 months postoperatively,2 cases received cyclophotocoagulation;IOP rised in 5 cases after 1 month,IOP was controlled under 21mmHg when they took 1-2 species hypotensive drugs.CONCLUSION:It is necessary to improve the filtering operation for success rate in glaucoma under high IOP.

R779.6