Silverstone B Z, Aizenman I, Landau C, Rozenman Y
Ophthalmology Dept., Shaare Zedek Medical Center, Jerusalem.
Harefuah. 2000 Apr 2;138(7):521-3, 616.
Deep sclerectomy (DS) can be used in glaucoma with increased intraocular pressure when medical treatment fails. It involves removing part of the ocular drainage apparatus. Resistance to intraocular fluid drainage is decreased, improving drainage and decreasing intraocular pressure. By avoiding anterior chamber penetration, DS diminishes frequency of the complications of filtering surgery. 24 eyes of 23 patients underwent DS for primary or secondary open angle glaucoma with elevated intraocular pressure not controlled medically. It included preparation of a 4.0 x 4.0 mm limbal-based external scleral flap, dissecting and removing most of an internal scleral flap (leaving it 1 mm smaller than the external flap), unroofing Schlemm's canal and removing fine endothelial tissue lining its inner walls. The external scleral flap was then repositioned and sutured. Collagen implants were not used. In some cases DS was combined with extracapsular cataract extraction and intraocular lens implantation. Mean intraocular pressure decreased from 24.8 +/- 3.9 mmHg initially to 12.8 +/- 4.4 mmHg 6 months after operation (p < 0.0001). There was no difference in postoperative intraocular pressure between DS as a single procedure or as part of a combined operation. Complications were mild and of short duration. If long-term follow-up shows that lowered intraocular pressures are maintained, DS should be a surgical option in earlier stages of glaucoma.
当药物治疗无效时，深层巩膜切除术（DS）可用于治疗眼压升高的青光眼。该手术需要切除部分眼部引流装置。降低眼内液引流阻力，改善引流并降低眼压。通过避免穿透前房，DS减少了滤过性手术并发症的发生频率。23例患者的24只眼接受了DS手术，用于治疗原发性或继发性开角型青光眼且眼压升高，药物治疗无法控制。手术包括制作一个4.0×4.0毫米的角膜缘外巩膜瓣，分离并切除大部分内巩膜瓣（使其比外巩膜瓣小1毫米），打开施莱姆管并去除其内壁的精细内皮组织。然后将外巩膜瓣重新定位并缝合。未使用胶原植入物。在某些情况下，DS与白内障囊外摘除术和人工晶状体植入术联合进行。平均眼压从最初的24.8±3.9毫米汞柱降至术后6个月的12.8±4.4毫米汞柱（p<0.0001）。DS作为单一手术或作为联合手术的一部分，术后眼压无差异。并发症轻微且持续时间短。如果长期随访显示眼压持续降低，DS应成为青光眼早期阶段的一种手术选择。
