Spaeth G L, Joseph N H, Fernandes E
Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. 1975 Mar-Apr;79(2):OP349-61.
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 an 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 patients with primary glaucoma treated with a Scheie procedure and 16.6 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 chambers 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) patients where endophthalmitis is a real concern, as in the 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接受了热巩膜造瘘周边虹膜切除术或采用改良沃森技术的小梁切除术，改良技术中巩膜瓣用缝线紧密缝合。在手术后长达三年的时间里，定期分析手术结果。手术的成功与否根据对眼压的影响以及眼睛的视觉能力来判断。由于外科医生的目标是将眼压降至特定水平，而不仅仅是降至便于统计分析的任意水平，因此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对疾病控制情况进行分级。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至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，接受巩膜瓣缝合小梁切除术的患者为16.6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。小梁切除术导致的无前房情况比谢伊手术少。小梁切除术中的降压程度与术后滤过程度直接相关。小梁切除术的相对适应证包括：（1）另一只眼的恶性青光眼；（2）慢性闭角型青光眼，其中认为虹膜切除术不足；（3）“高压性青光眼”，眼压低于20毫米汞柱并非必需；（4）低流入性青光眼，常规滤过手术后可能会出现持续性无前房；（5）眼内炎确实令人担忧的患者，如年轻人、远离医疗护理的人以及个人卫生差的人。小梁切除术在继发性青光眼中效果不佳，因此该手术可能相对禁忌。小梁切除术是一项有价值的手术，但不是青光眼手术的最终解决方案。选择该手术时应充分认识到其特定的优缺点。
