Silverstone B Z
Eye Dept., Shaare Zedek Medical Center, Jerusalem.
Harefuah. 2000 Nov;139(9-10):344-6, 407.
Increased intraocular pressure in glaucoma, resistant to maximal tolerated medical therapy, can be relieved by deep sclerectomy. Its advantage over classical trabeculotomy is fewer postoperative complications. This probably results from its being relatively noninvasive, since the anterior chamber is not penetrated. Successful deep sclerectomy requires preservation of the trabeculo-descemetic membrane, which forms part of the floor of Schlemm's canal. Aqueous flows from the anterior chamber across the trabeculo-descemetic membrane and into the ocular venous drainage. Despite the importance of its preservation, during deep sclerectomy it is perforated in 10-15% of cases. Coloring the endothelium lining the floor of the canal with gentian violet solution improves visualization of the membrane and thus aids in its preservation. Its use makes the procedure easier and should improve results.
青光眼患者眼压升高,即便采用最大耐受量的药物治疗仍无法控制,可通过深层巩膜切除术缓解。与传统小梁切开术相比,其优势在于术后并发症更少。这可能源于其相对无创,因为未穿透前房。成功的深层巩膜切除术需要保留小梁-Descemet膜,该膜构成施莱姆管底部的一部分。房水从前房穿过小梁-Descemet膜,进入眼静脉引流。尽管保留该膜很重要,但在深层巩膜切除术中,有10% - 15%的病例会将其穿破。用龙胆紫溶液给管底部的内皮细胞染色可改善对该膜的可视化,从而有助于其保留。使用龙胆紫溶液会使手术更简便,应该能改善手术效果。