急性闭角型青光眼持续高眼压状态不同处置方法的疗效分析

Therapeutic efficacy of different treatments for acute primary angle closure glaucoma under persistent ocular hypertension

目的比较分析急性闭角型青光眼患者持续高眼压状态下不同处置方法的疗效。方法 148例148眼急性闭角型青光眼行小梁切除术的患者,根据术前和术中不同处置方法分为3组:持续高眼压状态下术前眼压为50mmHg(1kPa=7.5mm-Hg)左右、前房深度≤1.9mm、术中抽吸玻璃体14例为第1组,持续高眼压状态下术前眼压为40mmHg左右、前房深度≥2.0mm、术中缓慢降压21例为第2组,眼压控制后行常规小梁切除术113例为第3组。对这3组资料进行回顾性分析,比较3组病例入院时、手术前及出院时的平均眼压及3组手术并发症的发生率。结果 3组患者平均年龄及出院时眼压比较,差异均无统计学意义(均为P>0.05);入院时眼压比较:第1组高于第3组(P<0.05),而第1组与第2组、第2组与第3组比较,差异均无统计学意义(均为P>0.05);术前眼压比较:第1组最高,第2组次之,第3组最低。3组手术并发症发生率分别为1/14(7.1%)、10/21(47.6%)、12/113(10.6%);第1组、第3组和第2组的手术并发症发生率比较,差异均有统计学意义(均为P<0.0125),而第1组和第3组的手术并发症发生率差异无统计学意义(P>0.05)。结论 术中抽吸玻璃体可降低持续高眼压状态下接受手术的急性闭角型青光眼患者的术中、术后并发症的发生率。

Objective To evaluate the therapeutic efficacy of different surgeries of patients with acute primary angle closure glaucoma under persistent ocular hypertension.Methods About 148 patients（148 eyes） of acute angle closure glaucoma which undergoing trabeculectomy,according to the different preoperative and intraoperative disposal methods were divided into three groups：preoperative intraocular pressure（IOP） with 50 mmHg（1 kPa=7.5 mmHg） under persistent ocular hypertension,anterior chamber depth be and less than 1.9 mm,and 14 cases with vitreous aspiration（group 1）;IOP with 40 mmHg under persistent ocular hypertension,anterior chamber depth be and more than 2.0 mm,IOP of 21 cases with gradually decrease（group 2）,trabeculectomy as the IOP were controlled to normal levels in 113 cases（group 3）.The three groups were retrospectively analyzed.The average IOP of cases in three groups on admission,before surgery and at discharge were compared,and surgical complication rates were also compared among three groups.Results There was no difference in average age and IOP at discharge among three groups（All P0.05）.IOP on admission in group 1 was higher than that in group 3（P0.05）,while no difference was found between group 1 and group 2,neither between group 2 and group 3（All P0.05）.Preoperative IOP was the highest in group 1,followed by group 2,and group 3 was the lowest.The incidences of complications were 7.1%（1/14）,47.6%（10/21） and 10.6%（12/113） in group 1,group 2 and group 3,respectively;There were significant differences in the incidences of complications for group 1 and group 3 compared with group 2（All P0.012 5）,while no difference was found between group 1 and group 3（P0.05）.Conclusion Aspiration of vitreous surgery has a significant effect on reducing the incidence of complications in and after the operation of patients with acute primary angle closure glaucoma under persistent ocular hypertension.