前路前段玻璃體切除術(shù)治療青光眼白內(nèi)障聯(lián)合術(shù)后的惡性青光眼

張影影，張立貴，綦躍勤

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·臨床報(bào)告·

前路前段玻璃體切除術(shù)治療青光眼白內(nèi)障聯(lián)合術(shù)后的惡性青光眼

張影影，張立貴，綦躍勤

?METHODS: Retrospective analysis. A total of 16 eyes of 14 patients with malignant glaucoma who had a history of cataract phacoemulsification removement +IOL combined with trabeculectomy (Phaco+IOL+Trab) were selected from Jun.2010 to Jun.2015 in our hospital. Due to ineffective conservative treatment, they were performed anterior segment vitrectomy. Through a clear corneal incision, iris retractor exposed 6 o’clock position of artificial crystal complex edge. Anterior and posterior capsular part resection combined with the corresponding parts of the anterior vitreous resection were performed.

?RESULTS: All patients were followed up for 12mo, all cases were successful in anterior chamber reconstruction. The mean best corrected visual acuity (BCVA, logMAR) was from 0.2±0.17 in the pre-operative to 0.5±0.29 in the last follow-up (P<0.05). The mean intraocular pressure (IOP) was 42.6±4.23mmHg in the pre-operative to 15.89±4.72mmHg in the last follow-up (P<0.05). Among them, 2 eyes needed a kind of anti-glaucoma drugs, 2 eyes with two kinds of anti-glaucoma drugs, the total success rate was 75%, partial success rate was 25%, the success rate was 100%. The mean anterior chamber depth was 0.62±0.23mm in the pre-operative to 3.49±0.57mm in the last follow-up (P<0.05). After the treatment, ciliary and choroidal detachment occurred in 2 cases were treated with conservative treatment, there were no serious complications such as corneal endothelial dysfunction, intraocular lens deviation, choroidal hemorrhage and retinal detachment in all patients during follow-up.

?CONCLUSION: Anterior segment vitrectomy is effective, simple, safe, easy to grasp and has less complications in treated the malignant glaucoma after surgery glaucoma combined with cataract compared with the posterior segment vitrectomy.

目的：探討前路前段玻璃體切除術(shù)治療青白聯(lián)合術(shù)后惡性青光眼的療效。

方法：回顧性分析2010-06/2015-06 間我院行超聲乳化白內(nèi)障摘除+人工晶狀體植入聯(lián)合小梁切除術(shù)后發(fā)生惡性青光眼的患者14例16眼，經(jīng)保守治療無(wú)效，采用前路前段玻璃體切除治療：經(jīng)透明角膜切口，虹膜拉鉤暴露6∶00位人工晶狀體復(fù)合體邊緣，行前后囊膜部分切除聯(lián)合相應(yīng)部位前段玻璃體切除術(shù)治療。

結(jié)果：所有患者經(jīng)過(guò)12mo的隨訪觀察，治療后前房均重建成功，平均最佳矯正視力(best corrected visual acuity，BCVA，LogMAR)由術(shù)前的0.2±0.17，提高到末次隨訪的0.5±0.29,差異具有統(tǒng)計(jì)學(xué)意義(P<0.05),平均眼壓由術(shù)前的42.6±4.23mmHg至末次隨訪的15.89±4.72mmHg,差異具有統(tǒng)計(jì)學(xué)意義(P<0.05), 其中2眼需用一種抗青光眼藥物，2眼需用兩種抗青光眼藥物，其完全成功率為75%，部分成功率25%，成功率100%,平均前房深度由術(shù)前的0.62±0.23mm至末次隨訪的3.49±0.57mm, 2眼治療后出現(xiàn)睫狀體脈絡(luò)膜脫離，經(jīng)保守治療恢復(fù)。所有患者在隨訪期間均未出現(xiàn)角膜內(nèi)皮功能失代償、人工晶狀體偏位、脈絡(luò)膜上腔出血、視網(wǎng)膜脫離等嚴(yán)重并發(fā)癥。

結(jié)論：前路前段玻璃體切除可以有效治療青白聯(lián)合術(shù)后惡性青光眼，較后路法更簡(jiǎn)單安全、易掌握、并發(fā)癥少。

青光眼；白內(nèi)障；前部玻璃體切除術(shù)；惡性青光眼

引用：張影影，張立貴，綦躍勤.前路前段玻璃體切除術(shù)治療青光眼白內(nèi)障聯(lián)合術(shù)后的惡性青光眼.國(guó)際眼科雜志2016;16(12):2317-2319

0引言

惡性青光眼又稱為睫狀環(huán)阻滯性青光眼，屬繼發(fā)性閉角型青光眼。如不及時(shí)處理或者處理不當(dāng)，可導(dǎo)致嚴(yán)重后果。部分患者保守治療如局部滴睫狀肌麻痹劑、全身應(yīng)用高滲劑及碳酸酐酶抑制、局部及全身使用皮質(zhì)類固醇可緩解，但藥物起效時(shí)間相對(duì)較長(zhǎng),易引起角膜及視神經(jīng)等組織不可逆性損傷,為避免復(fù)發(fā)，需要長(zhǎng)期滴用阿托品，可引起患者畏光、裸眼視力下降等不適，部分患者仍需手術(shù)治療,包括睫狀體扁平部抽吸玻璃體積液并前房成形、晶狀體摘除、YAG 激光晶狀體后囊膜及玻璃體前界膜切開(kāi)、前部玻璃體切除等[1]。……