目的:探讨青光眼常规小梁切除术中结膜瓣大小对降压效果及术后并发症的影响。方法:对10例已确诊双眼慢性闭角型青光眼的患者行常规小梁切除术+虹膜周切术,均做以穹窿为基底的结膜瓣,术中不用抗代谢药物。1眼做底边长10mm,高6mm等边三角形结膜瓣,另1眼做边长10mm,高6mm矩形结膜瓣(实际面积相当于前眼的两倍),其余手术步骤一致。于术后2d开始,每日测量眼压(非接触式眼压计),裂隙灯检查前房至术后7d拆线。分别于术后0.5,1,3mo复查。结果:患者10例扩大结膜瓣眼于术后全部发生浅前房,对侧无1例发生。其中1级浅前房5例,2级浅前房4例,3级浅前房1例。染色:2级浅前房中1例结膜瓣伤口漏。3级浅前房患眼下方结膜囊见滤过泡隆起。无1例发生睫状体脉络膜脱离。眼压测量:手术眼眼压均位于4～8mmHg,双眼相差<2mmHg。1,2级浅前房眼行滤枕加压、绷带包扎,3级浅前房眼行美多丽每日散瞳、滤枕加压、绷带包扎,均未口服及静脉使用降眼压药物。术后7d拆线时,术眼前房均正常,1例双眼眼压为14mmHg,9例眼压<10mmHg,双眼相差<2mmHg,双眼滤过泡大小一致。术后0.5,1,3mo复查双眼滤过泡无差别,眼压无差别。结论:扩大的结膜瓣并不能更有效的降低眼压,增大有效滤过泡的容积,反而会在术后早期增加滤过过强,眼压低,滤过泡大而弥散的并发症。

AIM:To investigate the antihypertensive effect and the impact of postoperative complications of different conjunctival flap size in the routine glaucoma trabeculec-tomy. METHODS:The eyes of 10 cases with chronic angle-closure glaucoma underwent conventional trabeculectomy + peripheral iris excision procedure,and the conjunctival fornix flap for the basement,without intraoperative antimetabolites. Equilateral triangle conjunctival flap with the bottom edge of 10mm long and 6mm high was performed in one eye,and the other eye was performed a long-10mm,high-6mm rectangular conjunctival flap (the actual size of the equivalent twice of the former),and the remaining operation steps were the same. From the second day after the operation,the daily measurement of intraocular pressure (IOP) (non-contact tonometer),slit-lamp examination of anterior chamber were performed for seven days until suture removal.RESULTS:The eyes with expanded conjunctival flap in 10 cases all had the occurrence of postoperative shallow anterior chamber of which there were 5 cases with one-stage shallow anterior chamber,4 cases with two-stage shallow anterior chamber,1 case with three-stage shallow anterior chamber. Dyeing:one case of two-stage shallow anterior chamber eyes with conjunctival flap wound leakage; filtration bulb of conjunctival sac intumesce in the bottom of the three-stage shallow anterior chamber eyes. No cilio-choroidal detachment occurred. IOP mea-surement:all IOPs were lower than 4-8mmHg,and the difference between binoculus was less than 2mmHg. One stage and two stage shallow anterior chamber eyes underwent filtering pillow compression and bandaging,and three stage shallow anterior chamber eyes were dilated with Mydrin-P daily,pressuring with filtering pillow and bandaging,without using ocular hypotensive agents orally or intravenously. When removing the suture 7 days after operation,the anterior chambers were normal; binocular IOPs were 14 mmHg in 1 case,less than 10mmHg in 9 cases,the binocular difference was less than 2mmHg,and the sizes of binocular filter bleb were the same. There was no difference in binocular filter bleb and IOP during the half month,one month,and three month review.CONCLUSION:The expansion of the conjunctival flap can not reduce IOP and increase the volume of the filtering bleb effectively,but can increase the occurrence of complications caused by strong filtering,low eye pressure,and large filter bleb. 

R779.6