目的:探讨青光眼滤过手术失败后再次显微手术的体会,比较传统小梁切除术和复合式小梁切除术的安全性和效果。方法:回顾性分析2008-08/2010-06我院收治的滤过手术失败的青光眼患者24例24眼,应用常规小梁切除术联合丝裂霉素10例(对照组),应用复合式小梁切除术(常规小梁切除术联合丝裂霉素和巩膜瓣可调节缝线)14例(观察组)。分析比较两组术后前房形成、眼压、滤过泡及并发症等情况,结果均经统计学处理。结果:患者24眼手术顺利,未引发爆发性脉络膜出血等严重并发症,术后追踪12mo。术后第1d浅前房发生率观察组为7%,明显低于对照组30%(P<0.05)。术后随访12mo时,观察组12眼(86%)眼压控制在6～21mmHg,对照组4眼(40%)眼压控制在6～21mmHg,两组间比较差异有统计学意义(P<0.05),观察组功能性滤过泡占86%,较对照组功能性滤过泡40%为多(P<0.05)。结论:对于青光眼滤过手术失败后的患者复合式小梁切除术的安全性和效果优于传统小梁切除术。手术中联合应用丝裂霉素和巩膜可调节缝线是手术成功的关键。

AIM:To study the clinical effects of compound trabeculectomy in the second filtration surgery and compare the safety and effectiveness between traditional trabeculectomy and compound trabeculectomy.METHODS:Totally 24 cases(24 eyes)of glaucoma for the second filtration surgery were randomly divided into two groups,14 cases (14 eyes) who underwent compound trabeculectomy(traditional trabeculectomy combined with mitomycin and adjustable sutured scleral flap) were observation group and 10 cases (10 eyes) underwent trabeculectomy(traditional trabeculectomy combined with mitomycin) as control to compare the postoperative intraocular pressure(IOP),filtration,the depth of anterior chamber and postoperative complications between the two groups.RESULTS:Twenty-four eyes were successful.In the follow-up of 12 months,on the first day of postoperation,the incidence rate of shallow anterior chamber in observation group and control group were 7% and 30% respectively(P<0.05).12 months later,the rate of IOP from 6-21 mmHg in observation group and control group were 86% and 40% respectively (P<0.05).Functional filtering bubbles were 86% and 40% respectively (P<0.05).CONCLUSION:Compound trabeculectomy is effective and safe in the second filtration surgery and superior to the traditional trabeculectomy.The key of successful operation lies in using mitomycin and adjustable sutured scleral flap.

R779.6