恶性青光眼的临床特点与防治方法

Clinical characteristics and control methods of malignant glaucoma

目的探讨恶性青光眼的临床特点与防治方法。方法回顾分析12例(13只眼)恶性青光眼的临床资料及治疗方法。本组病例角膜直径9.5～11 mm,平均10.8 mm。眼轴长17.8～22.5 mm,平均21.9mm,发生于慢性闭角型青光眼小梁切除术后11只眼,占84.6%。6只眼行药物治疗,其中2只眼联合YAG激光治疗;5只眼行晶状体摘除联合人工晶状体植入、后囊截开、前部玻璃体切除术;2只眼行晶状体摘除联合人工晶状体植入、小梁切除术,再次经睫状体平部行前部玻璃体切除、晶状体后囊膜部分切除术。结果出院时患者眼压在10～15mm Hg,中央及周边前房形成。随访观察10个月至5年,平均20个月,前房稳定,眼压15～21 mm Hg,平均18.7mm Hg。结论恶性青光眼好发于小角膜、短眼轴的慢性闭角型青光眼小梁切除术后,药物治疗、无晶状体眼联合Y-AG激光治疗可以控制部分恶性青光眼,晶状体摘除联合人工晶状体植入、后囊截开、前部玻璃体切除手术可以治愈药物不能控制的恶性青光眼。

Objective To explore the clinical features of malignant glaucoma and control Methods. Methods Retrospective analysis of 12 cases of 13 malignant glaucoma clinical data, treatment MethodsThe patients corneal diameter 9.5 - 11mm, mean 10.8 mm. Axial length 17.8 - 22.5 mm, mean 21.9 nun, Occurs in chronic angle-closure glaucoma after trabeculectomy 11, accounting for 84.6%. 6 eyes are drag treatment, in which two co-Y-AG laser treatment. 5eyes are done lens extraction and intraocular lens implantation combined with opening posterior capsule and anterior vitrectomy; two regular lens extraction and intraocular lens implantation and trabeculectomy, again by the ciliary body flat Pre-vitrectomy and lens posterior capsule partial excision. Results At discharge,the patients with intraocular pressure in the 10 - 15 mm Hg, the formation of the central and peripheral anterior chamber. Follow-up observation for 10 months to 5 years, an average of 20 months, the anterior chamber stability, and IOP 15 - 21 mm Hg, average 18.7 mm Hg. Conclusion Malignant glaucoma risk factors are small corneal and short axial length of chronic angle-closure glaucoma after trabeculetomy. Drug therapy, aphakia combined Y-AG laser therapy can control the part of the malignant glaucoma, lens extraction and intraocular lem implantation and opening posterior capsule and anterior vitrectomy surgery can cure drug beyond the control of malignant glaucoma.