青光眼小梁切除術(shù)的操作技巧與并發(fā)癥的避免課件

恭祝吳振中教授九十華誕Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2004-2017AsposePtyL青光眼小梁切除術(shù)的操作要點(diǎn)與并發(fā)癥的避免復(fù)旦大學(xué)附屬眼耳鼻喉科醫(yī)院孫興懷Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2004-2017AsposePtyL手術(shù)學(xué)基礎(chǔ)一角鞏膜緣的解剖組織學(xué)的定義手術(shù)學(xué)的定義病理學(xué)的改變角鞏膜緣結(jié)構(gòu)Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2004-2017AsposePtyL角鞏膜緣定義手術(shù)學(xué)(活體外觀)前部半透明區(qū)(約1mm寬)前彈力層止端到后彈力層止端的區(qū)域后部白色鞏膜區(qū)(約1mm寬)部(包含有小梁網(wǎng)和1管等結(jié)構(gòu))Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2004-2017AsposePtyL眼外角鞏膜緣形態(tài)角鞏膜(外)溝角膜和鞏膜過(guò)渡區(qū)的環(huán)行淺凹(由于角膜與鞏膜的曲率半徑不同而形成)球結(jié)膜止端與Tenon筋膜止端之間(難以辨別出溝凹,只有手術(shù)切開(kāi)和翻轉(zhuǎn)球結(jié)膜后才易識(shí)別)是重要的內(nèi)眼手術(shù)切口標(biāo)志Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2004-2017AsposePtyL角鞏膜緣手術(shù)解剖前部角膜和鞏膜組織交疊區(qū),呈半透明的灰藍(lán)色區(qū)帶從該區(qū)后界垂直切入眼內(nèi),切口在Schwalbe線或其稍后處(相當(dāng)于小梁網(wǎng)的前部無(wú)功能區(qū))后部主要為小梁網(wǎng)及Schlemm管,深埋于鞏膜內(nèi)溝中表層鞏膜瓣剝制后如Schlemm管充血時(shí)更容易識(shí)別該區(qū)帶,為非穿透小梁術(shù)關(guān)鍵部位Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2004-2017AsposePtyL角鞏膜緣臨床病理熟悉正常眼的解剖結(jié)構(gòu)個(gè)體差異(男、女;兒童、老年人)正確選擇內(nèi)眼切口的部位病理狀況下角鞏膜緣的變異原發(fā)性嬰幼兒型青光眼眼球擴(kuò)大,角鞏膜緣擴(kuò)張;發(fā)育不良原發(fā)性閉角型青光眼上方房角粘連關(guān)閉最早、最明顯切口應(yīng)適當(dāng)前移Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2004-2017AsposePtyL青光眼治療方式的選擇藥物激光}習(xí)慣性與先進(jìn)性、科學(xué)性手術(shù)一線治療first-line補(bǔ)充治療adjunctive有效性—青光眼病情的控制安全性損傷最小,危險(xiǎn)最小Evaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2004-2017AsposePtyL青光眼經(jīng)典的手術(shù)方式小梁切除術(shù)(+抗代謝藥物)濾過(guò),眼外引流房角房水引流功能障礙的大多數(shù)患眼BlebEvaluauononr.chAsposeslidesforNET4odientPEvaluationonly.CreatedwithAsposeSlidesforNET4.0dientProfilo71Copyright2004-2017AsposePtyL青光眼的術(shù)前準(zhǔn)備內(nèi)容:青光眼類型(房角),嚴(yán)重程度(眼壓、視功能)可能并發(fā)癥的預(yù)測(cè)和防范措施術(shù)前談話和患者知情同意(手于術(shù)目的是控制眼壓、保護(hù)視野,手術(shù)風(fēng)險(xiǎn)、減緩緊張心理)術(shù)前眼壓的控制及術(shù)后目標(biāo)眼壓設(shè)定藥物的應(yīng)用:抗青光眼藥及抗炎癥藥預(yù)防感染藥物鎮(zhèn)靜藥物清潔術(shù)眼Evaluauononr.chAsposeslidesfor