无玻璃体眼并发难治性青光眼的治疗策略及随访一年结果分析

The management of refractory glaucoma after vitreous surgery： A one-year follow-up

目的评价无玻璃体眼并发难治性青光眼的手术治疗方法及效果，分析其治疗策略。方法回顾性病例研究。分析绵阳市中心医院眼科2008年1月至2010年12月因玻璃体切除术后或硅油取出术后并发难治性青光眼患者17例，其中5例采用复合小梁切除手术（A组），8例采用青光眼引流阀植入手术（B组），4例[太J光感丧失采用810激光透巩膜睫状体光凝治疗（C组）。分析各组随访观察1年的眼压控制情况及并发症情况。采用重复测量的方差分析。结果各组在术后早期眼压均控制良好，术后1年A组术眼眼斥平均为（30．44±4．23）mmHg，联合降眼压药物治疗后可将眼压控制在正常范围；B组平均眼压为（20．78±4．54）mmHg；C组平均眼压为（30．79±3．23）mmHg，达到缓解疼痛目的。与治疗前比较，各组眼压明显降低（止32．20、46．81、27．69，P〈0．01）。3组术后均无严重并发症。结论玻璃体切除术后或硅油取出术后并发青光眼因有多次手术史，结膜瘢痕重，属于难治性青光眼，常规复合小梁切除手术因滤过道瘢痕化，远期效果不理想，需联合药物治疗；青光眼引流阀是安全有效的治疗方法，远期降眼压效果理想；对于光感消失患者810激光透巩膜睫状体光凝治疗术后降压药效果确切．是很好的补充手段。

Objective To examine the effectiveness and safety of 3 kinds of surgeries in eyes with refractory glaucoma following vitrectomy. Methods A retrospective study of a nonomparative case series of 17 eyes of 17 patients who had undergone refractory glaucoma surgery following vitrectomy was conducted from Jan. 2008 to Dec. 2010. Patients were divided into three groups： group A （5 eyes）, patients were treated with trabeculectomy, group B （8 eyes）, patients were treated with glaucoma valve implantation, and group C （4 eyes）, patients were treated with 810 nm laser transcleral eyelophotoeoagulation. Data were analyzed using repeated measure ANOVA. Results All three groups had good control of intraoeular pressure （IOP） in nonage after surgery. One year after surgery, the mean IOP of group A was 30.44±4.23 mmHg. Medications were needed to lower IOP in this group. The mean IOP of group B was 20.78＋4.54 mmHg, which was considered ideal lOP. The mean lOP of group C was 30.79±3.23 mmHg. The differences were significant （F=32.20, 46.81, 27.69, P〈0.01）, compared to preoperative levels. No serious complications occurred after surgery. Conclusion For refractory glaucoma following vitrectomy, trabeeuleetomy is less effective over the long term and glaucoma valve implantation is a better treatment method. Treatment with 810 nm laser transeleral eyelophotocoagulation can be useful for blind eyes.