Jonescu-Cuypers C P, Seitz B
Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Kirrberger Strasse, 66421 Homburg/Saar.
Ophthalmologe. 2009 Nov;106(11):1029-39. doi: 10.1007/s00347-009-2071-5.
Of the filtering procedures employed, trabeculectomy is the one most frequently used for surgical therapy in primary open angle glaucoma patients. Intra- and postoperative complications must be detected promptly and treated adequately. Many complications arise within the first weeks, such as bleb scaring, decreased flow beneath the scleral flap, extensive filtration with choroidal detachment and anterior chamber narrowing. Fibrin reaction, corneal dellen, iris prolapse, conjunctival leakage and ciliary body detachment are seen more rarely. With prophylactic pre- and perioperative application of antibiotics, wound infections are rare and the risk of endophthalmitis following trabeculectomy remains small. Careful surgical planning requires special consideration of the conjunctiva and provides the basis for long-term success as long as intensive follow-up treatment is ensured. The success of trabeculectomy depends on the preoperative, intraoperative as well as postoperative condition and in particular on bleb development. Early detection of postoperative complications, especially in terms of early scaring in the bleb area, enables implementation of adequate therapeutic measures, such as needling procedures and early bleb revision. Close patient monitoring substantially increases long-term success rates.
在采用的滤过手术中，小梁切除术是原发性开角型青光眼患者手术治疗中最常用的一种。必须及时发现并充分治疗术中及术后并发症。许多并发症在最初几周内出现，如滤过泡瘢痕形成、巩膜瓣下引流减少、广泛滤过伴脉络膜脱离和前房变窄。纤维蛋白反应、角膜瓣下积液、虹膜脱垂、结膜渗漏和睫状体脱离则较为少见。通过预防性地在术前和围手术期应用抗生素，伤口感染很少见，小梁切除术后发生眼内炎的风险仍然很小。精心的手术规划需要特别考虑结膜情况，并在确保强化随访治疗的前提下，为长期成功奠定基础。小梁切除术的成功取决于术前、术中和术后的情况，尤其是滤过泡的形成。早期发现术后并发症，特别是滤过泡区域的早期瘢痕形成，有助于实施适当的治疗措施，如针刺操作和早期滤过泡修复。密切的患者监测可显著提高长期成功率。
