目的：观察下方小梁切除术治疗青光眼滤过术后眼压失控的疗效和安全性。

方法：回顾性分析51例61眼青光眼滤过术后眼压失控行下方小梁切除术患者的资料，统计术前、术后眼压、视力和降眼压药物的数量，以及术中、术后并发症。采用Kaplan-Meier生存分析计算手术成功率。

结果：术后随访时间为6～76(平均30.15±14.10)mo。61眼术前眼压35.98±10.01mmHg，术后1wk，1、3、6mo，1a及末次随诊眼压分别为9.62±4.90、13.15±4.51、16.05±7.37、16.48±6.81、16.68±6.42、16.77±7.56mmHg，与术前眼压相比，均有差异(P<0.001)。术后6mo，1、2a的完全成功率分别是62%、49%、36%，部分成功率分别是93%、85%、81%，34眼(56%)形成功能性滤过泡，术前采用降眼压滴眼液3.33±0.77种，术后3mo降至1.41±1.44种(t=9.86，P<0.001)。术后未出现滤过泡感染、眼内炎等严重并发症。

结论：下方小梁切除术操作难度相对较大，但对于青光眼滤过术后眼压控制不佳的患者，仍可以作为一种安全有效的治疗方案。

METHODS: A retrospective analysis was conducted to identify 51 glaucoma patients with 61 eyes that had undergone trabeculectomy at the inferior limbus for patients of IOP after failed glaucoma filtration. The preoperative and postoperative IOP, visual acuity and number of IOP-lowering drugs, as well as intraoperative and postoperative complications were extracted. Surgical success rates were calculated using Kaplan-Meier survival analysis.

RESULTS: The postoperative follow-up time ranged from 6-76(mean 30.15±14.10)mo. The preoperative IOP of 61 eyes was 35.98±10.01mmHg, the IOP after the surgery at 1wk, 1, 3, 6mo, 1a and the IOP of last follow-up visit were 9.62±4.90, 13.15±4.51, 16.05±7.37, 16.48±6.81, 16.68±6.42, 16.77±7.56 mmHg respectively, all of these were different compared to the preoperative IOP(P<0.001). The postoperative complete success rates at 6mo, 1 and 2a were 62%, 49% and 36%, respectively and the partial success rates were 93%, 85% and 81%, respectively. There were 34 eyes(56%)formed functional filtration blebs. There were 3.33±0.77 kinds of IOP-lowering eye drops used before surgery, and it was decreased to 1.41±1.44 kinds of eye drops(t=9.86, P<0.001)at 3mo after surgery. There was no severe complication observed such as filtering bleb infection and endophthalmitis.

CONCLUSION: Trabeculectomy at the inferior limbus offers the opportunity for patients with uncontrolled IOP after failed glaucoma filtration, and it can still be used as a safe and effective treatment for patients, although it is relatively difficult to operate.