Spaeth G L, Joseph N H, Fernandes E
Ophthalmic Surg. 1975 Spring;6(1):27-38.
Seventy-one patients with glaucoma needing surgical correction had either a peripheral iridectomy with a thermal sclerostomy or a trabeculectomy utilizing a modification of Watson's technique in which the scleral flap was closed tightly with sutures. Results of surgery were analyzed at intervals up to and including three years following the surgical procedure. The success of the operations was judged both in terms of the effect on intraocular pressure as well as on the visual ability of the eye. Since the surgeon's aim is to lower intraocular pressure to a particular level, not simply to an arbitrary level that facilitates statistical analysis, the control of the disease was graded in terms of how completely the operative procedure fulfilled the goal set by the surgeon at the time the decision to operate was made. While this method of grading success introduces a subjective element, a more valid assessment of the true value of the surgery may be obtained. The results suggest that the Scheie procedure lowers pressure to a lower level and for a longer duration than does the trabeculectomy (mean intraocular pressure three years postoperatively was 12.3 mm Hg in cases of primary glaucoma treated with a Scheie procedure and 16 mm Hg in those with trabeculectomy with a sutured scleral flap). In this study the long-term visual result was apparently no different with the Scheie procedure and trabeculectomy. Trabeculectomy causes fewer flat anterior changes than the Scheie procedure. The degree of pressure lowering in trabeculectomy is directly related to the amount of postoperative filtration. The relative indications for trabeculectomy include: (1) malignant glaucoma in the other eye; (2) chronic angle closure glaucoma where an iridectomy is considered insufficient; (3) "high pressure glaucoma" where pressure below 20 mm Hg is not essential; (4) low inflow glaucoma in which persistent flat anterior chambers may be expected following routine filtration surgery; and (5) cases where endophthalmitis is a real concern, as in the very young, those remote from medical care and those with poor personal hygiene. Trabeculectomy gives such poor results in secondary glaucoma that the procedure is probably relatively contraindicated. Trabeculectomy is a valuable operation, but not the final solution to glaucoma surgery. It should be chosen with full recognition of its specific advantages and disadvantages.
71例需要手术矫正的青光眼患者，要么接受了带热巩膜造口术的周边虹膜切除术，要么采用了改良的沃森技术进行小梁切除术，该技术中巩膜瓣用缝线紧密缝合。在手术过程之后直至包括三年的时间间隔内，对手术结果进行了分析。手术的成功与否是根据对眼压的影响以及眼睛的视觉能力来判断的。由于外科医生的目标是将眼压降低到特定水平，而不仅仅是为了便于统计分析的任意水平，所以疾病的控制是根据手术程序在做出手术决定时实现外科医生设定目标的完整程度来分级的。虽然这种成功分级方法引入了主观因素，但可能会获得对手术真正价值更有效的评估。结果表明，与小梁切除术相比，谢伊手术能将眼压降低到更低水平且持续时间更长（原发性青光眼患者接受谢伊手术后三年的平均眼压为12.3毫米汞柱，接受带缝合巩膜瓣小梁切除术的患者为16毫米汞柱）。在本研究中，谢伊手术和小梁切除术的长期视觉结果显然没有差异。小梁切除术引起的前房变平情况比谢伊手术少。小梁切除术中眼压降低的程度与术后滤过的量直接相关。小梁切除术的相对适应证包括：（1）另一只眼患恶性青光眼；（2）慢性闭角型青光眼，认为虹膜切除术不足时；（3）“高压性青光眼”，眼压低于20毫米汞柱并非必要；（4）低流入性青光眼，常规滤过手术后可能会出现持续性前房变平；（5）存在眼内炎实际担忧的情况，如非常年轻的患者、远离医疗护理的患者以及个人卫生差的患者。小梁切除术在继发性青光眼中效果不佳，该手术可能相对禁忌。小梁切除术是一种有价值的手术，但不是青光眼手术的最终解决方案。选择时应充分认识到其特定的优缺点。
