內路鞏膜瓣復通術治療青光眼聯(lián)合白內障術后失敗患者的療效

張影影，張立貴，綦躍勤

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內路鞏膜瓣復通術治療青光眼聯(lián)合白內障術后失敗患者的療效

張影影，張立貴，綦躍勤

Hubin Aier Eye Hospital, Binzhou 256600, Shandong Province, China

?METHODS:Twenty-seven cases(27 eyes) of glaucoma combined cataract surgery(3mo) in the early failure were treated with that the phacoemulsification auxiliary hook into anterior chamber under the original sclera flap, open from the inside have adhesion of the sclera flap. Postoperative follow-up 12mo, the intraocular pressure and best corrected visual acuity were observed.

?RESULTS: The postoperative follow-up was 12mo. There were functional filtering bleb in 14(52%) eyes; and the IOP was below 21mmHg in 17 eyes(63%) without any anti-glaucoma drug, and in 7 eyes(26%) with 1-2 categories of lower intraocular pressure(IOP) drugs, and 3 eyes(11%), failure and the success rate was 89% after 12mo. Average intraocular pressure after 1wk, 1mo, 3mo, 6mo and 12mo were(7.1±4.3) mmHg,(10.5±5.1) mmHg,(15.1±4.8) mmHg,(16.8±5.2) mmHg,(17.3±5.1) mmHg, significantly lower than the IOP preoperatively(30.2±6.8)mmHg (P<0.01). Average visual acuity(all of the following were best corrected vision) after 1wk, 1mo, 3mo, 6mo and 12mo was(0.32±0.52),(0.52±0.42),(0.55±0.39),(0.53±0.47),(0.54±0.42). Postoperative 1wk visual acuity deeper than preoperative(0.46±0.44)(P<0.05), more than all improved compared with preoperative(P<0.05). Postoperative anterior chamber bleeding in 5(19%) eyes, all absorbed itself in 3 to 5 days; ciliochoroidal detachment in 7(26%) eyes, except one case need operate, others were conservative treatment to heal. Postoperative continuous low intraocular pressure concurrent macular edema was 1 eyes(4%), 4mo healed after treatment.

?CONCLUSION: It is a safe and effective method thattreating phacoemulsification cataract remove combined with trabeculectomy early postoperative failure with open sclera flap recanalization by phacoemulsification auxiliary hook interred the anterior chamber.

目的：探討內路鞏膜瓣復通術治療青光眼聯(lián)合白內障術后早期失敗患者的效果。

方法：選取青光眼聯(lián)合白內障術后早期(3mo內)失敗的患者共27例27眼，采用超聲乳化輔助鉤進入前房至原鞏膜瓣下,從內部頂開已粘連的原鞏膜瓣使之復通治療。術后隨訪12mo，觀察患者的眼壓及最佳矯正視力。

結果：術后12mo，14眼(52%)形成功能性濾過泡；17眼(63%)不用任何藥物眼壓<21mmHg，7眼(26%)加用1～2種降眼壓藥物眼壓<21mmHg，3眼(11%)失敗,成功率為89%。術前平均眼壓30.2±6.8mmHg。術后1wk,1、3、6、12mo平均眼壓分別為7.1±4.3、10.5±5.1、15.1±4.8、16.8±5.2、17.3±5.1mmHg，手術前后眼壓比較有統(tǒng)計學意義(P<0.01)。術前最佳矯正視力平均0.46±0.44,術后1wk,1、3、6、12mo平均最佳矯正視力分別為0.32±0.52、0.52±0.42、0.55±0.39、0.53±0.47、0.54±0.42。除術后1wk較術前下降，其余皆較術前好轉，差異有統(tǒng)計學意義(P<0.05)。術后前房出血5眼(19%)，均在3～5d內自行吸收；脈絡膜脫離7眼(26%)，除1眼需要脈絡膜上腔放液和前房成形外余皆保守治療痊愈；術后持續(xù)低眼壓并發(fā)黃斑水腫1眼(4%)，持續(xù)4mo經積極治療而愈。

結論：內路鞏膜瓣復通術治療青光眼聯(lián)合白內障術后早期失敗患者是一種安全有效的方法。

白內障；青光眼；手術；濾過泡；眼壓

引用：張影影，張立貴，綦躍勤.內路鞏膜瓣復通術治療青光眼聯(lián)合白內障術后失敗患者的療效.國際眼科雜志2016;16(11):2145-2147

0　引言

我國是閉角型青光眼發(fā)病大國,隨著白內障超聲乳化技術的普及和提高,越來越多的青光眼合并白內障的患者行白內障超聲乳化吸除+人工晶狀體植入聯(lián)合小梁切除術[1-2](簡稱Phaco+IOL+Trab), 但隨著時間的推移，濾泡功能不良、眼壓升高而難以用藥物控制的病例不斷增加。對于此類患者，有必要進行再次抗青光眼手術治療，但此類無晶狀體眼或人工晶狀體眼病情復雜，手術難度大，常規(guī)手術成功率低。現將我科對青光眼濾過術后早期(3mo內)濾過不良、眼壓升高的部分患者，采用內路鞏膜瓣復通術的治療結果報告如下。

1　對象和方法

1.1對象選取2012-01/2015-06我科共收治Phaco+IOL+Trab術后高眼壓患者27例27眼，男11例11眼，女16例16眼，年齡54～82歲。……