目的:探讨小梁切除术中改良巩膜瓣的制作方法,观察术后远期疗效。方法:对50例85眼不同类型的青光眼行小梁切除(观察组),术中制作隧道式4mm×6mm巩膜瓣,巩膜瓣的后缘与巩膜床间作三针跨度为4mm的闭合式缝合,对照组50例82眼行常规小梁切除术。结果:术后平均随访8～30mo。视力:观察组有7眼较术前提高,5眼视力下降,其余视力无明显变化,差异无统计学意义。眼压:观察组术后末次随访平均眼压与术前平均眼压比较,差异有统计学意义(P<0.05)。视盘参数:观察组视乳头盘沿面积(RA,m2)、盘沿体积(RV,mm3)、平均神经纤维层厚度(mRNFL,mm)与术前比较有改善,差异有统计学意义(P<0.05)。视野:观察组5眼视野较术前扩大,3眼视野缩小,其余视野无明显变化。与对照组比较:观察组眼压控制率和功能性滤过泡形成率均高于对照组(P<0.05)。并发症发生率低于对照组(P<0.05)。结论:改良式小梁切除术,术后远期眼压控制效果明显,并发症少,可改善视功能,是一种安全有效的手术方法。

·AIM:To observe the long-term effect of reformed trabeculectomy.·METHODS:Totally 50 cases 85 eyes of glaucoma received the trabeculectomy with sclera flap(4mm×6mm),and the sclera flap was sutured by three needles(span 4mm)in observed group.50 cases 82 eyes of glaucoma received the conventional trabeculectomy in control group.·RESULTS:The postoperative follow-up period was 8-30 months.Visual acuity was higher than before operation in 7 eyes,5 eyes were worse than before operation,other eyes remained the same(P>0.05).There was significant statistical difference between preoperative and postoperative intraocular pressure(IOP)(P<0.05).There was significant statistical difference between preoperative and post-operative rim area(RA),rim volume(RV)and mRNFL(P<0.05).5 eyes expanded in visual fields relatively,3 eyes decreased,othes remained the same.There was significant statistical difference between two groups in the control rate of IOP,the rate of filtering bleb formation and complications(P<0.05).·CONCLUSION:The reformed trabeculectomy can effectively accommodate IOP,reduce complications and improve visual function.It is a safe and effective surgery method.·

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中国广西壮族自治区卫生厅科研课题基金资助项目(No.Z2006154)~~