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目的探讨复合式小梁切除术治疗闭角型青光眼的疗效。方法对传统小梁切除术进行改良,术中对小梁切除口进行缩小,使用抗代谢药物丝裂霉素抑制滤过区瘢痕形成,采取前房穿刺,注射平衡液,促使前房及滤过泡的形成。采用此改良术式对44例(50眼)闭角型青光眼进行了治疗观察。结果术后视力提高11眼(22%),保持不变36眼(72%)视力下降3眼(6%)。术后第1天前房全部形成,4眼发生浅前房,发生率为8%;术眼经加压包扎,散瞳处理后前房恢复正常。出院时,50眼眼压均控制在正常范围,术后随访1个月,仍在正常范围。术后1 d,44眼形成大而扁平的滤枕,呈半透明状;有3眼滤区不明显,经按摩眼球后滤区明显;另有3眼术后半年滤过泡壁薄、大,其中2眼滤过泡破裂,后经修补恢复,1眼滤过泡不明显。结论复合式小梁切除术治疗闭角型青光眼,安全、有效、疗效确切。
Objective To investigate the curative effect of compound trabeculectomy in angle-closure glaucoma. Methods The traditional trabeculectomy was improved. The trabeculectomy was narrowed during operation. Mitomycin was used as an antimetabolite to inhibit scar formation in the filtering area. Anterior chamber puncture and balanced fluid injection were used to promote the anterior chamber and filtration Bubble formation. Forty-four patients (50 eyes) with angle-closure glaucoma were treated with this modified procedure. Results Postoperative visual acuity improved in 11 eyes (22%), remained unchanged in 36 eyes (72%), and decreased in 3 eyes (6%). The anterior chamber was formed on the first day after operation, and the anterior chamber occurred in 4 eyes. The incidence of the anterior chamber was 8%. The ocular surface was pressure-packed and the anterior chamber returned to normal after mydriasis. At discharge, 50 eyes were controlled intraocular pressure in the normal range, follow-up 1 month after surgery, still in the normal range. After 1 day, 44 eyes formed a large and flat filter pillow, which was translucent; there was no obvious filter area in 3 eyes, and the filter area was obvious after eyeball massage. In the other 3 eyes, the filtered bubble wall was thin and large , Of which 2 eyes filtered bleb rupture, after repair recovery, 1 eye bleb is not obvious. Conclusion Combined trabeculectomy for angle-closure glaucoma is safe, effective and effective.