晶状体玻璃体切除联合青光眼减压阀治疗晶状体脱位继发性青光眼

Lentectomy and vitrectomy combined with Ahmed glaucoma valve for secondary glaucoma with lensdisplacement

目的评价晶状体玻璃体切除术联合青光眼减压阀治疗晶状体脱位继发性青光眼的疗效。方法回顾性分析32例（32眼）外伤性晶状体脱位合并继发性青光眼资料，手术方法采用标准玻璃体切除三通道切口，颞上方植入Ahmed减压阀，对术前、术后视力、眼压及并发症等情况进行分析。结果术后6个月复诊，矫正视力提高者28眼，视力不变4眼；术前平均眼压为（39．58±15．84）mmHg（1mmHg=0．133kPa），术后3d平均眼压为（9．66±2．84）mmHg，术后1周平均眼压为（11．50±3．41）mmHg，术后1个月平均眼压为（13．36±2．42）mmHg，术后6个月平均眼压为（15．80±3．80）mmHg，均显著低于术前眼压。主要并发症有前房积血、滤过过强致浅前房、引流管阻塞及滤过泡瘢痕化等。结论晶状体玻璃体切除联合青光眼减压阀治疗晶状体脱位继发性青光眼可以降低眼压，保护视功能，是治疗该类青光眼较好的术式。

Objective To evaluate the clinical effect of lentectomy and vitrectomy combined with Ahmed glaucoma valve for secondary glaucoma with lens displacement. Methods The data in 32 cases （ 32 eyes） of secondary glaucoma with traumatic lens displacement were analysed retrospectively. The routine op- eration of lentectomy and vitrectomy were done, combined with Ahmed glaucoma valve implanting in the su- perior temporal Tenon＇ s Capsule. Visual acuity, intraocular pressure and complication were observed preop- eratively and postoperatively. Results The corrected visual acuity of 28 eyes were improved, the visual a- cuity of 4 eyes were constant postoperatively after 6 mouths. The average intraocular pressure was （39.58 ± 15.84） mmHg preoperatively, （9.66 ± 2.84 ） mmHg 3 days after surgery, （ 11.50 ± 3.41 ） mmHg in 1 week, （ 13.36 ± 2.42 ） mmHg in 1 month, （ 15.80 ± 3.80 ） mmHg in 6 months, the average intraocular pres- sure was descended noticeably. The predominant complications were hyphema, shallow anterior chamber, drainage tube blocking, filtered bleb scarfing. Conclusion Lentectomy and vitreetomy combined with Ahmed glaucoma valve is a kind of operation ideally for complex traumatic glaucoma caused by lens displace- ment, with lower postoperative intraoeular pressure and preserving visual function.