Sherwood M B, Smith M F
Department of Ophthalmology, University of Florida College of Medicine, Gainesville 32610-0284.
Ophthalmology. 1993 Jan;100(1):85-90. doi: 10.1016/s0161-6420(93)31688-x.
A major complication of unvalved drainage tube implants is hypotony. Occluding stents to internally block the tube, but which lie exposed in the inferior fornix, have been described. The authors report modifications of this technique.
A nonexposed 3-0 Supramid suture is used to internally block the tube, with the end placed subconjunctivally. Small venting slits are made in the extrascleral portion of the tube to provide early control of intraocular pressure. Molteno implants were placed in 32 eyes of 29 patients using these modifications.
Mean preoperative intraocular pressure was 30.3 mmHg on an average of 2.6 medications. The stent was pulled without difficulty in the office treatment room a mean of 26 days postoperatively. Intraocular pressure from postoperative day 2 until the day of stent removal ranged from 2 to 26 mmHg, with 72% of eyes having intraocular pressure between 5 and 19 mmHg. There were 3 (9.4%) minor complications in the 32 eyes, with 1 case of early anterior chamber shallowing and 2 cases of moderate choroidal detachments, which settled spontaneously. With an average follow-up of 10.2 months, mean intraocular pressure at the final visit was 13.4 mmHg on an average of 1 medication.
The "occluding stent" described here can be a helpful adjunct to unvalved drainage tube surgery in preventing early postoperative hypotony.
无瓣膜引流管植入的一个主要并发症是低眼压。已有文献描述了使用阻塞支架在管内进行阻塞，但支架暴露于下穹窿。作者报告了该技术的改进方法。
使用一根未暴露的3-0 Supramid缝线在管内进行阻塞，线头置于结膜下。在引流管的巩膜外部分制作小的排气狭缝，以便早期控制眼压。采用这些改进方法为29例患者的32只眼植入了莫尔顿引流装置。
术前平均眼压为30.3 mmHg，平均使用2.6种药物。术后平均26天在门诊治疗室顺利取出支架。术后第2天至取出支架当天眼压范围为2至26 mmHg，72%的眼眼压在5至19 mmHg之间。32只眼中有3例（9.4%）发生轻微并发症，1例早期前房变浅，2例中度脉络膜脱离，均自行缓解。平均随访10.2个月，末次随访时平均眼压为13.4 mmHg，平均使用1种药物。
本文所述的“阻塞支架”在预防术后早期低眼压方面可作为无瓣膜引流管手术的有益辅助手段。
