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目的观察巩膜瓣可调整缝线在预防青光眼小梁切除术后浅前房中的作用。方法对60例(89眼)青光眼患者,在手术显微镜下,做穹隆部或角膜缘为基底结膜瓣,常规的梯形巩膜与小梁切除术。在巩膜瓣两侧做可拆缝线。球结膜切口连续紧密缝合。术后观察眼压、前房深度、结膜滤过泡、眼内组织反应与并发症。当手术后前房形成稳定或眼压回升大于10mmHg时,拆除巩膜调整缝线。术后平均随访时间6个月。结果术后第一天前房形成良好74只眼,术后巩膜瓣缝线松解时间5-30天,平均11天,缝线松解后,结膜滤过泡明显增大。60例患者术后随访眼压3-18mmHg,平均(9.1±2.75)mmHg与术前眼压相比,差异非常显著,所有患者随访中均未应用抗青光眼药物治疗,呈现血管少、弥散而微隆起的功能性结膜滤过泡。结论巩膜瓣可调整缝线能促进青光眼小梁切除术后早期前房的形成,减少前房形成迟缓所致的并发症。有利于小梁切除术后长期滤过作用,提高青光眼手术的安全性和有效性。
Objective To observe the role of scleral flap adjustable suture in preventing shallow anterior chamber after glaucoma trabeculectomy. Methods 60 patients (89 eyes) with glaucoma under the operation microscope, the dome or limbal conjunctival flap, the conventional trapezoidal sclera and trabeculectomy. Scleral flap on both sides to do detachable suture. Conjunctival incision closely continuous suture. Postoperative intraocular pressure, anterior chamber depth, conjunctival filtration bleb, intraocular tissue reaction and complications. When the anterior chamber formation after surgery or intraocular pressure rise greater than 10mmHg, remove the scleral adjustment suture. The mean follow-up time was 6 months. Results On the first day after operation, the anterior chamber was well formed in 74 eyes. The postoperative scleral flap suture release time was 5-30 days, an average of 11 days. After suture release, the conjunctival filtration bleb was significantly increased. 60 patients were followed up intraocular pressure 3-18mmHg, mean (9.1 ± 2.75) mmHg compared with preoperative intraocular pressure, the difference was significant, all patients were not treated with anti-glaucoma medication, showing less blood vessels, diffuse and micro Uplift of the functional conjunctival filtration bleb. Conclusion Scleral flap adjustable sutures can promote the formation of early anterior chamber after trabeculectomy and reduce the complications caused by delayed formation of anterior chamber. Is conducive to long-term filtration after trabeculectomy, glaucoma surgery to improve the safety and effectiveness.