Kolker A E, Kass M A, Rait J L
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis.
Trans Am Ophthalmol Soc. 1993;91:131-41; discussion 141-5.
We attempted to reduce some of the postoperative complications of trabeculectomy by using releasable scleral flap sutures. This technique allows an initial tight closure of the scleral flap with the option to increase aqueous humor outflow in the early postoperative period. We reviewed our experience with trabeculectomy and releasable sutures in 146 eyes (134 patients) and compared these cases with a prior series of 128 eyes (124 patients) that underwent trabeculectomy with permanent scleral flap sutures. In the control group, 42 eyes (32.8%) had clinically detectable shallowing of the anterior chamber in the postoperative period. In contrast, shallow anterior chamber was noted in 21 eyes (14.4%) in the group with releasable sutures (P = .0003). Flat anterior chamber, defined as iridocorneal touch to the pupil margin, occurred in 11 control eyes (8.6%) but in only 2 eyes (1.4%) with releasable sutures (P = .0078). Surgical intervention to drain suprachoroidal fluid and re-form the anterior chamber was required in eight control eyes (6.2%) but in only one study eye (0.7%) (P = .014). At 1 year of follow-up, the two groups were similar in terms of mean intraocular pressure, the need for ocular hypotensive medications, and failure rate.
我们试图通过使用可松解巩膜瓣缝线来减少小梁切除术的一些术后并发症。这项技术允许最初对巩膜瓣进行紧密缝合，并可在术后早期增加房水流出。我们回顾了146只眼（134例患者）小梁切除术及可松解缝线的经验，并将这些病例与之前一组128只眼（124例患者）接受永久性巩膜瓣缝线小梁切除术的情况进行比较。在对照组中，42只眼（32.8%）在术后出现临床上可检测到的前房变浅。相比之下，可松解缝线组有21只眼（14.4%）出现前房变浅（P = .0003）。前房扁平定义为虹膜角膜接触到瞳孔边缘，在11只对照眼中出现（8.6%），但在可松解缝线组仅2只眼出现（1.4%）（P = .0078）。8只对照眼（6.2%）需要进行手术干预以引流脉络膜上腔液体并重新形成前房，但在研究组仅1只眼（0.7%）需要（P = .014）。在随访1年时，两组在平均眼压、降眼压药物需求和失败率方面相似。
