年龄小于45岁原发性慢性闭角型青光眼的显微手术治疗

A clinical study of microsurgery on management of primary chronic angle-closure glaucoma in patients aged less than 45 years

目的探讨原发性慢性闭角型青光眼年轻患者临床治疗的经验和体会。方法对临床收治的41例52眼、年龄<45岁、临床确诊为进展期或晚期原发性慢性闭角型青光眼的病例进行抗青光眼显微手术处理的病例进行回顾性分析。结果随访时间平均(32.50±5.08)个月:男16例,女25例;进展期28眼,晚期24眼;52眼均行抗青光眼手术-复合式小梁切除手术治疗;眼轴长平均(22.40±1.63)mm,其中<21mm占17.31%.小眼球占13.46%;前房深度平均(1.90±0.39)mm,其中<1.9 mm占61.46%;超声生物显微镜检查高褶虹膜构型占59.62%,其中睫状突位置靠前者10眼;术前平均眼压(41.73±12.26)mm Hg,末次术后平均眼压(12.03±4.57)mm Hg,术前后眼压差异有统计学意义(t=3.520,p<0.001)。术后并发症主要有浅前房,恶性青光眼。恶性青光眼手术处理方式包括玻璃体抽液、前段玻璃体切割以及超声乳化白内障吸除加人工晶状体植入术治疗。4眼因眼压控制不理想,行二次抗青光眼手术治疗。结论年轻原发性慢性闭角型青光眼患者,女性多见,多伴有眼轴短、前房浅等特点,抗青光眼复合式小梁手术治疗要注意防治术后浅前房、恶性青光眼的发生。术前详细检查、手术操作精细以及有效处理术后并发症将有助于提高手术成功率和减少并发症。

Objective To explore the clinical experience on management of primary chronic angle- closure glaucoma （PCACG） in young patients. Methods A retrospective study was set up for 41 cases （52 eyes） aged 〈45 years with PCACG which were performed trabeculectomy on management of glaucoma. Results The mean follow-up was （32. 50 ±5.08） months. There were 16 males and 25 females. Twenty-eight eyes were in advanced stage while 25 eyes in late stage. The mean axial length was （ 22.40 ± 1.63 ） mm, in which 17. 31% was 〈21 mm and 13.46% was nanophthalmos. The mean anterior chamber depth was （ 1.90 ±0. 39） nun, in which 61.46% was 〈 1.9 mm. Ultrasonic Biomicrescopy identified that plateau iris was the most common underlying etiology （59.62%）, in which 10 eyes presented anteriorly positioned ciliary processes. There was a statistically significant difference in intraocular pressure （IOP） reduction postoperatively vs preoperatively （P 〈0. 001 ）. The main postoperative complications were shallow anterior chamber and malignant glaucoma. Surgical treatments for malignant glaucoma included aspiration of fluid from the vitreous by a pars plana incision, anterior vitrectomy and phacoemulsification plus intraocular lens implantation. Four eyes failed to control IOP and received second filtration surgery. Conclusion The PCACG patients with younger age have more frequency on female and have characteristic of short axis of eyeball, fiat anterior chamber and have a potential risk of postoperative sustained shallow anterior chamber and malignant glaucoma. A careful ophthalmic examination, delicate surgical procedure and well-managed technique of complications were suggested on management of younger PCACG patients.