［关键词］ 青光眼；巩膜咬切术；疗效观察
Forward of Glaucoma Deepseated Sclera Resecton's Size Curative Effect Clinic Be Observed
Abstract:The late result of subscleral sclerectomy of 130 eyes(100 cases) was studied．As the sclerectomy of larger size(1.5 mm × 1.5 mm)was compared with that of smaller size(1.5 mm×1.5 mm)，the two groups being strictly matched in stratum，the 1.5×3.0 group had higher success rate (96.2％vs 85.5％，P＜0.05)，more functioning filtration blebs(91.7％vs68.6％,P<0.01)，and less eyes with visual acuity reduced after operation (21.7%vs48.1%,P＜0.05).There was no statistically significant difference in the incidence of complications between these two groups.Accordingly 1.5 mm ×3.0 mm was recommended as the size of subscleral sclerelfctomy instead of 1.5 mm ×1.5 mm,so as to improve the success rate.
Key words:Glaucoma ;Sclera resecton;Curative effect
目前巩膜咬切器普遍应用到临床，但咬切孔的大小影响临床疗效观察很少报道。因此我们对1992年5月至2001年5月青光眼巩膜深层咬切术的住院患者进行随诊，对不同咬切孔的远期效果进行分析比较，报告如下。
1 资料和方法
1.1 一般资料 原发性青光眼患者共100例130只眼，其中咬切孔1个大小为1.5 mm×1.5 mm者50例70眼，咬切2孔即孔大1.5 mm ×3 mm者50例60眼，见表1。
表1 不同大小的咬切孔结果比较(略)
1.2 方法 结膜瓣以穹隆部为基底，板层巩膜瓣5 mm×5 mm,用巩膜咬切器咬除深层角巩膜缘组织1次或平行咬切2次使切口在与角膜缘平行的方向上长达1.5 mm或3 mm作周边虹膜切除，巩膜瓣用10／0尼龙线间断缝合2针，结膜瓣带浅层巩膜固定2针，完成手术时球结膜下注射庆大霉素2万 U及地塞米松2 mg对比的两组除咬切孔大小不等以外其余手术操作相同。随诊时检查：视力、眼压、杯盘比、滤过泡及晶体、滤过泡参考Kronfeld分型［1］，以明显隆起、壁薄、贫血为Ⅰ型；轻度隆起壁略厚，轻度贫血为Ⅱ型；以毫无隆起及贫血为Ⅲ型；以隆起壁厚呈硬结状，充满血管者为Ⅳ型(包裹型)。Ⅰ型、Ⅱ型为有功能滤过泡，Ⅲ型、Ⅳ型缺乏功能。
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