脉络膜上腔引流术治疗难治性青光眼的远期效果

Long-term effects of aqueous fluid internal drainage operation from epichoridal spaces on refractory glaucoma.

目的对脉络膜上腔引流术治疗难治性青光眼进行临床研究，并评估此术式的远期效果。方法回顾性分析运用脉络膜上腔引流术治疗难治性青光眼37例（37眼）。手术成功的判定标准：不用或仅局部应用抗青光眼药物，眼压控制存5～21mmHg，且视力稳定、角膜透明者视为手术成功。结果随访时间均在1年以上，平均随访（34．3±13．7）月。术后平均眼压（18．2±6．3）mmHg，较术前平均眼压（58．4±23．8）mmHg明显降低（P〈0．05）；新生血管性青光跟虹膜及前房角新生血管术后2周内完全消退；12例（32．43％）浅前房；9例（24．32％）低眼压；8例（21．62％）脉络膜脱离；1例（2．70％）眼球萎缩。25例（67．57）术后2d前房积血吸收。手术成功率1、2、3a分别为86．49％、81．08％、75．68％。结论长期随访观察及临床研究显示脉络膜上腔引流术设计合理，手术成功率高，并发症少，远期疗效好。

Objective To evaluate the long-term effects of aqueous fluid internal drainage operation from epiehoroidal spaces on refractory glaucoma. Methods 37 cases （37eyes） of refractory glaucoma treated wilh epichoroidal spaces drainage between 2002 and 2006 were studied. Definitions of successful operation were deter mined as （1） intraoeular pressure （IOP） were controlled between 5mmHg and 21mmHg with vision improved or no descented and clear cornea. （2） no antiglaucoma medication or only local medication of topical antiglaucoma drops. Results All cases were followed-up for over 1 year, the mean follow-up time was （ 34.3 ± 13.7） months. After operation, the average lOP was significantly lowered to （18.2±6.3） mmHg from （58.4 4 ±23.8）mmHg （P 〈 0.05 ） . Iris neovaseular were disappeared in 2 weeks ; 12 cases （32.4%） were shallow of anterior chamber; 9 eases （24. 3%） were lower IOP; 8 cases （21.6%） were detachment of choroids; 1 case （2. 7% ） was atrophy of eyeball. However, some cases （67.5%） have hyphema absorbed in just 2 days. The success rate of this operation was 78. 3%, 64. 8%, 56.7% at 1, 2, and 3 years respectively. Conclusion Long-term observations have confirmed the effects of epiehoroidal spaces drainage that had a high success rate, fewer complications during the follow-up time.