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目的 探讨改良转移结膜瓣对矫正青光眼小梁切除术后薄壁囊状滤过泡的临床效果。方法 剪开滤过泡周围的结膜 (保留原滤过泡 ) ,游离转移上方或颞侧球结膜 筋膜组织 ,加固覆盖于经局部冷冻的变性囊状泡表面 ,转移结膜瓣的前缘固定缝合于周边角膜的槽状浅沟内。转移结膜瓣不够松弛时 ,在穹窿部做一减张性球结膜 筋膜组织切开。结果 46例 (5 2只眼 )术后随访 6个月至 4年 ,平均眼压由术前 (4 2 5± 1 33)mmHg(1mmHg=0 133kPa)提高至术后 (12 98± 5 70 )mmHg,差异有显著性 (t=3 2 6 ,P <0 0 1)。 5 1只眼仍保留滤过功能 ,2 0只眼的结膜渗漏和 6只眼的黄斑水肿消失 ,术后视力较术前有明显改善 (χ2 =16 6 5 ,P <0 0 1)。 1只眼术后滤过泡消失 ,眼压升高 ,需加用抗青光眼药物以维持正常眼压 ,视为手术失败。结论 转移结膜瓣加固术是矫正薄壁囊状泡性低眼压、减轻黄斑水肿、修复结膜渗漏或破裂、防止眼内感染的有效手术方法。
Objective To investigate the clinical effect of modified conjunctival flap on the treatment of thin-walled cystoid bleb after glaucoma trabeculectomy. Methods The conjunctiva around the bleb (retaining the original filtering bleb) was excised and the upper and temporal conjunctival fascia tissues were dissociated. The surface of the transplanted conjunctival flap was covered by the local freezing of the surface of the degenerated vesicular bursa In the peripheral corneal groove shallow groove. Metastatic conjunctival flap is not enough relaxation, in the fornix to do a reduction of tension conjunctival fascia tissue incision. Results 46 cases (52 eyes) were followed up for 6 months to 4 years postoperatively. The mean intraocular pressure (IOP) increased from 425 ± 1 33 mmHg (1mmHg = 0 133kPa) to (1298 ± 5 70) ) mmHg, the difference was significant (t = 326, P <0.01). 51 eyes still retained filtration function, conjunctival leakage in 20 eyes and macular edema in 6 eyes disappeared. Postoperative visual acuity was significantly improved compared with that before operation (χ2 = 1665, P <0.01). One eye disappeared after filtering bleb, intraocular pressure, need to add anti-glaucoma drugs to maintain normal intraocular pressure, as the failure of surgery. Conclusion Transjunctional conjunctival flap reinforcement is an effective surgical method to correct thin-wall vesicular hypotension, reduce macular edema, repair leakage or rupture of conjunctiva and prevent intraocular infection.