Weill-Marchesani综合征继发青光眼手术治疗的新观察

The new surgical options for secondary glaucoma in Weill-Marchesani syndrome

目的探讨Weill-Marchesani综合征继发青光眼的手术治疗方法。设计回顾性小样本病例系列。研究对象2009年6月至2010年1月在北京同仁医院住院手术治疗的年龄13~32岁的Weill-Marchesani综合征继发青光眼晚期患者3例。方法 2例为晶状体半脱位继发青光眼,采取晶状体及前部玻璃体切除术联合Ahmed阀植入术或直视下眼内睫状体光凝术。1例为人工晶状体（IOL）眼继发闭角型青光眼,采取Ahmed阀植入术联合前部玻璃体切除术。主要指标眼压。结果术后随访4~6个月。采取Ahmed阀植入术联合手术的2例患者不用药物眼压控制在21 mm Hg以下;采取眼内睫状体光凝术的1例患者局部用2种降眼压药物眼压稳定控制在21 mm Hg以下。1例术后早期发生严重脉络膜脱离,1例术后早期出现恶性青光眼,经保守治疗恢复。结论本文有限的病例结果提示,Weill-Marchesani综合征继发青光眼采用晶状体及前部玻璃体切除术联合青光眼引流阀植入术或眼内睫状体光凝术可有效地控制眼压。

Objective To report the new surgical methods for secondary glaucoma in Weill-Marchesani syndrome.Design Retrospective small sample case series.Participants Three cases with Weill-Marchesani syndrome patients with secondary advanced glaucoma aged 13-32 years in Beijing Tongren Hospital from June 2009 to January 2010.Methods We performed anterior vitrectomy and lensectomy combined with Ahmed valve implantation or endoscopic cyclophotocoagulation in 2 cases with secondary glaucoma of lens subluxation.Ahmed valve implantation combined with anterior vitrectomy was performed in one case with secondary glaucoma of intraocular lens.Main Outcome Measures Intraocular pressure.Results The follow-up was 4-6 months.The intraocular pressure was controlled to less than 21 mmHg without hypotensive eyedrop in 2 cases of Ahmed valve implantation,and with 2 hypotensive eyedrops in 1 case of endoscopic cyclophotocoagulation.One case appeared serious choroidal detachment and 1 case malignant glaucoma as early complications after surgery,and got recovery with medications or laser treatment.Conclusion This small sample study shows that anterior vitrectomy and lensectomy combined with Ahmed valve implantation or endoscopic cyclophotocoagulation may be potential choices for secondary glaucoma in Weill-Marchesani syndrome.