摘要
目的 探讨恶性青光眼不同手术方式的治疗效果。设计 回顾性病例系列。研究对象 2009-2011年武汉爱尔眼科医院31例（34眼）恶性青光眼患者，发生于小梁切除术后、术中及青白联合术后者分别为28眼（82.4%）、4眼（11.8%）、2眼（5.9%）。方法 回顾恶性青光眼发病特点、治疗方式及效果。平均随访（21.7±6.5）个月。主要指标 矫正视力、眼压、前房深度及并发症。结果 阿托品治疗有效者4眼 （11.8%），激光后囊膜及玻璃体前界膜切开2眼（5.9%），前段玻璃体切除联合前房成形术12眼（35.3%），超声乳化白内障摘除人工晶状体植入术8眼（23.5%），超声乳化白内障摘除人工晶状体植入联合前段玻璃体切除8眼（23.5%）。术后1个月恶性青光眼复发者3眼。眼压由治疗前的（42.5＆plusmn;11.8）mm Hg降至治疗后的（15.3＆plusmn;4.2）mm Hg（P=0.000）；前房轴深由治疗前的（0.3＆plusmn;0.4）mm升至（2.4＆plusmn;0.4）mm（P=0.000）。术前矫正视力大于指数的18眼术后矫正视力提高至0.1~0.3者7眼，0.3以上者6眼。1眼玻璃体切除术后少量玻璃体积血，1眼角膜内皮失代偿，1眼阿托品过敏。结论 恶性青光眼多需晶状体玻璃体手术治疗；根据患者具体情况适时手术治疗多可获得较好的保存视力效果。
Objective To investigate the efficacy of different surgical treatments for malignant glaucoma. Design Retrospective case series. Participants 31 malignant glaucoma patients （34 eyes） admitted in Wuhan Aier Eye Hospital in 2009-2011. Methods Disease characteristics, treatment methods and results of all patients were reviewed. The mean follow-up time was 21.7 ± 6.5 months. Main Outcome Measures corrected visual acuity, intraocular pressure, anterior chamber depth and complications. Results Over the 34 eyes, malignant glaucoma occurred after trabeculectomy in 28 eyes （82.4%）, during trabeculectomy in 4 eyes （11.8%）, after combined cataract extraction with trabeculectomy in 2 eyes （5.9%）. Four eyes （11.8%） were well controlled with atropine. Nd-YAG laser capsulotomy and disruption of anterior hyaloid face were performed in 2 eyes （5.9%）, vitrectomy combined with anterior chamber reconstruction in 12 eyes （35.3%）, cataract extraction and intraocular lens implantation in 8 eyes （23.5%）, and combined cataract extraction with vitrectomy in 8 eyes （23.5%）. Recurrent malignant glaucoma 1 month after treatments was observed in 3 eyes. Intraocular pressure before and after treatment was 42.5±11.8, 15.3±4.2 mm Hg, respectively （P=0.000）. Anterior chamber depth before and after treatment was 0.3±0.4, 2.4±0.4 mm, respectively （P=0.000）. Eighteen eyes with counting finger or more of corrected visual acuity before treatment became 0.1-0.3 in 7 eyes, and 0.3 or more in 6 eyes after treatment. Vitreous hemorrhage, corneal endothelial decompensation and topical atropine allergy appeared respectivel each in 1 eye. Conclusions Malignant glaucoma usually needs lens-vitreous surgery. Timely surgical treatments based on specific circumstances of patients may archive better vision effect. （Ophthalmol CHN, 2013, 22： 38-41）
出处
《眼科》
CAS
2013年第1期38-41,共4页
Ophthalmology in China
