Glaucoma combined trabeculectomy intraocular pressure control related factors of the recent
Authors: Zhao Feng Hua, He Xin, Wei Xu, Ru quella, Dong Xiaoyun
【Abstract】 Objective To investigate the compound glaucoma trabeculectomy intraocular pressure controlling factors of the recent stages of the clinical relevance of glaucoma filtration surgery to improve on recent success rate of IOP control and reduce the incidence of clinical complications. Methods in March 2001 ~ April 2007 in our hospital admitted 957 patients with angle-closure glaucoma were divided into surgical method according to A, B groups, A group (March 2001 ~ January 2006) using the traditional trabecular resection, B group (February 2006 ~ April 2007) using combined trabeculectomy, and two
groups of patients before surgery and after IOP data were compared and analyzed. The results combined trabeculectomy used at various stages due to different treatment programs, making postoperative IOP control and surgical success rate is
markedly improved, and effectively reducing the surgical complications, the incidence of refractory glaucoma. Conclusion compound trabeculectomy IOP control in the near future clearly superior to the traditional trabeculectomy, surgery is simple, safe, should be used as anti-glaucoma
conventional surgical method to promote.
Key words glaucoma; trabeculectomy, compound type; intraocular pressure control
In recent years, combined trabeculectomy in a rapidly restore and maintain anterior chamber depth, according to the need to improve filtration capacity effectively inhibit scar formation and other aspects, a good clinical effect, is
increasingly being applied to the treatment of glaucoma . I Bureau since February 2006 began to carry out combined
trabeculectomy surgery, by year's continuous exploration and practice, to achieve a satisfactory clinical effect, treatment of the report now follows.
1 Data and methods
1.1 General information on cases in this group were 957
cases (957), which in March 2001 ~ April 2007 eye hospital inpatients are diagnosed by gonioscopy angle-closure glaucoma.
Surgery will be based on different ways patients were divided into A group (traditional surgical group) and B (a modern complex surgical group), which, from 2001 to January 2006 a total of 704 cases (704), for A group, using traditional trabeculectomy resection; February 2006 ~ April 2007 a total of 253 cases (253), for B group, the use of modern combined trabeculectomy surgery. The above cases, male 371 cases (371), female 586 cases (586), male to female ratio is about 1:1.58; aged 36 to 67 years, mean 51 years of age; intraocular pressure in ocular hypertension were randomly admitted to hospital the same day as the standard, two patients
preoperative pressure distribution in Table 1. Table 1 Distribution of intraocular pressure in patients with preoperative
A group of 1.2 treatments iris weeks using traditional trabeculectomy resection, preoperative miosis agents and other intraocular pressure lowering drugs. B group were treated with combined trabeculectomy iris weeks resection, preoperative topical non-steroidal anti-inflammatory drugs and hormones,
preoperative 3 ~ 6 days out miotic postoperative routine eye massage. Both groups after the use of local antibiotics, hormones and non-steroidal anti-inflammatory drugs.
Cases from the two groups after 1 week of IOP outcome,, B group of IOP control was better than group A, Table 2. Table 2 Distribution of intraocular pressure in patients with
3.1 Traditional trabeculectomy related factors of postoperative intraocular pressure control after trabeculectomy IOP out of control near future mainly for the early postoperative (within 1 week) High intraocular pressure (? 21 mm Hg) and the intraocular pressure is too low (? 5 mm
Hg), so that the evolution of conventional glaucoma refractory glaucoma, or there ciliary body, choroidal detachment, resulting in greater difficulty in follow-up treatment, and
intensified medical risks. The above-mentioned phenomenon
because of the following two aspects.
3.1.1 inadequate filtration bleb formation showed poor or deep anterior chamber depth, intraocular pressure. Common reasons are: scleral flap is too large or too thick, tight sutures, early scar formation, filtration port plug (Iris plug), and pupillary block (postoperative inflammatory reaction leading to the pupil after the adhesion).
3.1.2 filtration bleb too strong for the formation of the
performance of non-performing, shallow anterior chamber or anterior chamber disappeared, low intraocular pressure or high intraocular pressure (seen in malignant glaucoma). Common reasons are: scleral flap is too small or too thin, too loose
sutures and conjunctival wound leakage.
3.2 compound trabeculectomy analysis of the main technical advantages and points of
3.2.1 emphasis on medication before and after surgery patients before and after non-steroidal anti-inflammatory
drugs and hormones (generally 0.1% fluorine A selection of loose-lung) to use, to reduce preoperative ocular inflammatory cell infiltration and hyperemia response, and effectively reduce the postoperative inflammation and scarring of the filtration channel. In particular, postoperative medication, there should be long enough and in accordance with filtration channel formation in a timely manner to adjust. As the long-
term application of pilocarpine may be organized under the conjunctiva caused by an increase in inflammatory cells,
destruction of blood - aqueous barrier, stimulate fibroblast proliferation and lead to postoperative reperfusion barriers, significantly reduced the success rate of filtration surgery, it is usually in the preoperative 2 weeks out (at least 3 days
before surgery). Reposted elsewhere in the paper for free
3.2.2 Intraoperative medication commonly soaked with 0.4 mg / ml mitomycin C (MMC) of the cotton bandage, before opening the anterior chamber placed under the scleral flap and
conjunctival flap 1 ~ 4 min (depending on patient's age, the conjunctiva of may be), take out a balanced solution or later to fully wash the wound with normal saline to remove residual drug. MMC can effectively interfere with fibroblast DNA and
RNA protein synthesis and cell division, affected fibroblast proliferation, migration and angiogenesis to prevent surgical area, and inhibit the function of ciliary process cells, so that to reduce the amount of aqueous humor is generated to prevent the filtration channel scar formation. Likewise, MMC right sclera, iris, also have strong side effects, can lead to more complications, it should be noted that strictly the indications and the drug concentration, retention time.
3.2.3 sclera scleral flap size, thickness and
postoperative-related filtration resistance should be based on patient age, preoperative intraocular pressure and expectations of the specific circumstances such as filtration capacity varies.
3.2.4 Open the anterior chamber paracentesis before the
15 ? puncture with a knife at the temporal corneal limbus within the 0.5 mm for anterior chamber puncture, and the slow release of a small amount of aqueous humor (2 ~ 3 drops). Paracentesis to reduce intraocular pressure not only to avoid
the complications of intraocular pressure caused by rapid reduction, but also with the completion of surgery when postoperative shallow anterior chamber intraocular pressure adjustment and to resume the role of the anterior chamber .
3.2.5 trabeculectomy removed non-functional parts of the
main trabecular area, preoperative gonioscopy should be carefully carried out to determine the exact location trabeculectomy.
3.2.6 iris for a wide resection of the sclera around the removal of the basement, the width should be more than trabeculectomy area, in order to avoid clogging the iris occurred after filtration mouth. Resection of the size generally advisable to see the three ciliary process.
3.2.7 scleral suture with 10-0 nylon suture sutured
scleral flap to the top of conventional, and in one or both sides of the waist to do the Department of conjunctival surface through the dome into the needle reverse scleral flap suture slipknot, to no leakage is appropriate to regulate the suture removal should be based on postoperative intraocular pressure and eye massage of decisions, such as satisfactory IOP control can be gradually removed after 2 weeks.
3.2.8 the next day after the eye massage can be done under the intraocular pressure of the eye massage, eye massage should be noted that the right intensity, and to avoid surgical incisions, mainly in the eye softened as the standard, can not massage the number of terms.
Trabeculectomy in glaucoma filtration surgery as the
primary means, in the past 30 years, has been widely used in clinical treatment of glaucoma . However, surgery itself,
the limitations of clinical development and medical limitations. For a long time, as to how to achieve effective control of early intraocular pressure, lasting for the future to maintain a more satisfactory state of IOP to prevent progressive visual impairment and reduce the incidence of
postoperative complications, but also increasingly become a topic of concern more widely . In recent years, along with MMC and other drugs in glaucoma clinical applications and improved surgical technique, combined trabeculectomy with intraocular
pressure control due to good capacity and a lower incidence of complications, has gradually become the treatment of glaucoma is another an important weapon, and has gradually replace the traditional trabeculectomy trends.
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2 Limei Yu. Glaucoma study. Beijing: People's Health Publishing House, 2004,594. Reposted elsewhere in the paper
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