高眼压青光眼的滤过手术治疗

Filtering operation for glaucoma under high intraocular pressure

目的:探讨在高眼压状态下行青光眼滤过手术的方法和技巧,并观察疗效。方法:选取高眼压青光眼患者50例,手术前眼压>40mmHg。行复合式小梁切除(小梁切除+虹膜周切术),提前前房穿刺减压,手术中巩膜瓣下及筋膜下使用MMC(0.2或0.4g/L),较宽的虹膜根切口,根据手术中眼压和前房形成状况选择玻璃体腔穿刺抽液,做巩膜瓣可调整缝线。结果:术后随访3mo,视力提高26例,不变24例。41例眼压<21mmHg;1例术后1wk出现浅前房,再次行前段玻璃体切除、前房成形术;1例行白内障摘出、后囊截开、前房成形术;2例2mo后行睫状体光凝;5例患者术后1mo眼压升高,联合使用1～2种降眼压药物后,眼压控制在21mmHg以下。结论:高眼压状态下行青光眼滤过手术,需要改良、细化手术的部分操作,可以提高手术成功率,挽救残存视力。

AIM： To approach the method and skill of operation for glaucoma under high intraocular filtering pressure （IOP） and observe the curative effect. METHODS： All of 50 glaucoma patients with high lOP which was 〉 40mmHg preoperatively. Trabeculectomy combined with peripheral iridectomy were performed in anterior chamber to decompress using MMC （0.2g/L or 0.4g/L） under scleral flap and fascia during operation. RESULTS： Followed-up for 3 months after operation, vision was improved in 26 cases, unchanged in 24 cases; lOP of 41 cases was 〈 21mmHg;1 case received anterior vitrectomy and anterior chamber plastic operation because of occurring shallow anterior chamber at 1 week postoperatively; extraction of cataract, posterior capsule split and anterior chamber plastic operation were performed in 1 case; at 2 months postoperatively, 2 cases received cyclophotocoagulation; IOP rised in 5 cases after 1 month, IOP was controlled under 21mmHg when they took 1-2 species hypotensive drugs. CONCLUSION：It is necessary to improve the filtering operation for success rate in glaucoma under high IOP.