迟缓型恶性青光眼的特点及治疗方法的选择

Character and treatment of tardy malignant glaucoma

目的:探讨迟缓型恶性青光眼的特点及治疗方法的选择。方法:观察12例(14眼)迟缓型恶性青光眼出现的时间、眼压、前房深度及处置方法的选择。结果:术后出现恶性青光眼的时间1～8(平均3.1)mo;前浅房程度:Ⅱ°:7眼,Ⅲ°:7眼;眼压:28～46(平均34.6)mmHg。3眼经药物治疗后恢复前房;其余分别选择手术治疗;2眼行玻璃体水囊抽吸+前房成形术;2眼行玻璃体水囊抽吸+前房成形+Phaco+后囊截开术;3眼行前部玻璃体部分切除+Phaco+后囊截开术;4眼行前部玻璃体部分切除+Phaco+后囊截开+IOL术;术后均恢复前房。术后眼压14～23(平均18.3)mmHg。结论:慢性炎症刺激引起的瞳孔后粘连是迟缓型恶性青光眼发生的主要原因。前部玻璃体部分切除+Phaco+后囊截开+IOL术是迟缓型恶性青光眼最有效的治疗方法。

AIM： To investigate the character and the treatment of tardy malignant glaucoma. METHODS： The occurring time of tardy malignant glaucoma after surgery and the extent of shallow anterior chamber were observed among 12 cases （14 eyes） with tardy malignant glaucoma. And then, the treatment was chosen. RESULTS： The occurring time of tardy malignant glaucoma after surgery was around from 1-8 （average 3.1） months. In 14 eyes, shallow anterior chamber in 7 eyes at Ⅱ° and other 7 eyes at Ⅲ°. The intraocular pressure was 28-46 （average 34. 6） mmHg. Three eyes were cured well, 2 eyes were treated by vitreous water- bag aspiration combined with anterior chambers reconstructing, 2 eyes by vitreous water-bag aspiration combined with anterior chambers reconstructing, phacoemulsification and lens posterior capsotomy, 3 eyes by anterior vitrectomy combined with phacoemulsification and anterior chambers reconstructing, and 4 eyes by anterior vitrectomy combined with Phaco ＋ IOL ＋ lens posterior capsotomy. All anterior chambers were restored normal. The intraocular pressure after surgery was 14-23 （ average 18.3） mmHg. CONCLUSION： The posterior synechia of the iris caused by chronic inflammation is the main causes of tardy malignant glaucoma, The anterior vitrectomy combined with Phaco ＋ IOL ＋ lens posterior capsotomy is the most effective treatment to tardy malignant glaucoma.