高眼压下行小梁切除术治疗急性闭角型青光眼的临床观察

Clinical observation of trabeculectomy with high intraocular pressure to treat acute angle-closure glaucoma

目的观察高眼压下施行小梁切除术治疗急性闭角型青光眼的临床效果。方法急性闭角型青光眼35例（45只眼）,经药物或YAG激光治疗眼压仍高于36 mmHg（1 mmHg=0.133 kPa）,予前房穿刺术等处理后,施行小梁切除术治疗。术后对患者的视力、眼压、滤过泡、前房、瞳孔、脉络膜、视网膜等情况进行观察,随访2~18个月。结果 1.视力：术后10 d内视力提高者16只眼（35.6%）,术后11～20d视力提高者20只眼（44.4%）,至随访结束视力无变化者9只眼（20.0%）。2.眼压：术后7~12 d内高眼压者（24~50 mmHg）15只眼（33.3%）,对症处理降至正常。3.滤过泡：大多在7~18 d形成;远期随访有1例发生滤泡瘢痕。4.并发症：浅前房8只眼（17.8%）,包括恶性青光眼2只眼（4.44%）,经治好转;前房出血6只眼（13.3%）,经治出血吸收;瞳孔后轻度粘连16只眼（35.6%）;无伤口渗漏、暴发性脉络膜上腔出血及脉络膜视网膜脱离。5.手术总成功率89.9%。结论在高眼压状态下行小梁切除术,术后反应一般都较重,术后恢复及滤过泡形成的时间相对较长,易发生前房出血、浅前房及恶性青光眼等并发症;借助前房穿刺术等,并注意术中轻巧操作及术后恰当处理,可提高手术的成功率。

OBJECTIVE To observe the clinical effects of trabeculectomy of high intraocular pressure in the treatment of acute angle-closure glaucoma.METHODS Paracentesis in the auxiliary downstream trabeculectomy were performed to 35 cases（45 eyes） of acute angle-closure glaucoma,after drugs of lowering the intraocular pressure or YAG laser peripheral iridotomy,the IOP still higher than 36 mmHg.Two to eighteen months postoperative visual acuity,intraocular pressure,bleb,anterior chamber,pupil,chorioretinal,etc.were monitored.RESULTS 1.Vision：10 days after operation the visual acuity improved in 16 eyes（35.6%）,postoperative 11 to 20 days vision improved in 20 eyes（44.4%）;to the end of follow-up the visual acuity remained unchanged in 9 eyes（20.0%）.2.Intraocular pressure： postoperative 7~12 days of high IOP（24~50 mmHg） in 15 eyes（33.3%）,symptomatic treatment decreased to normal.3.Bleb：mostly formed in the 7~18d,long-term follow-up had a case of follicular scar;4.Complication： shallow anterior chamber in 8 eyes（17.8%）,including malignant glaucoma 2eyes（4.44%）,improving after treatment;hyphema in six eye（13.3%）,bleeding absorption after treatment;pupil in 16 eyes（35.6%） of mild adhesion;no wound leakage,fulminant choroidal hemorrhage and chorio-retinal detachment.5.Surgical success rate was 89.9%.CONCLUSIONS Trabeculectomy with high intraocular pressure state,postoperative reactions generally were heavier,postoperative recovery and bleb formation of a relatively long time.Easily happened complications were hyphema,shallow anterior chamber and malignant glaucoma etc.With the anterior chamber paracentesis and attention to intraoperative light operation and postoperative appropriate treatment could improve the success rate of surgery.