Moroz人工角膜植入术后并发青光眼患者的临床分析

Glaucoma and Moscow Eye Microsurgery complex （Moroz） keratoprosthesis

目的 探讨Moroz人工角膜植入术后并发青光眼患者的发病原因及相关诊疗措施.方法 回顾性病例系列研究.2000年4月至2011年6月对90例（90眼）患者行Moroz人工角膜植入术,15例（15只眼）术后并发青光眼.12例（12只眼）术前有青光眼病史,3例（3眼）术后继发青光眼.所有患者术后1～3个月定期随访,详细记录每名患者眼压、最佳矫正视力、手术前后相关病史、药物及治疗方案.结果 Moroz人工角膜可以显著提高患者术后最佳矫正视力.15例（15只眼）并发青光眼的患者中有8例（53.3％）术前诊断为碱烧伤.5例（5只眼）术后行睫状体冷凝控制眼压,最佳矫正视力分别从0.8降至0.2,0.25降至光感,0.3降至0.1,0.2降至眼前手动,0.4降至指数.结论 Moroz人工角膜植入术后青光眼发生率较低,术前碱烧伤可能是其高危因素.诊断需综合患者的眼压、视野和眼底检查结果.可考虑全身及局部降眼压进行治疗.

Objective To investigate the relationship between glaucoma and Moscow Eye Microsurgery Complex （Moroz） keratoprosthesis.Methods Analysis and retrospective review of consecutive clinical case series.A total of 90 patients had a Moroz keratoprosthesis implantation between Apr,2000 and Jun,2011 at our hospital.Fifteen eyes of 15 patients were included in this research.Twelve eyes were identified glaucoma before Moroz keratoprosthesis surgery,and 3 eyes developed glaucoma afterward.Intraocular pressure （IOP）,best-corrected visual acuity （BCVA）,and treatment of glaucoma were recorded at 1 to 3 months after the Moroz keratoprosthesis implantation.Results Moroz keratoprosthesis surgery improved vision dramatically in the majority of patients in our study.The most common preoperative corneal diagnosis was alkali burn （8 eyes,53.3％）,which maybe the risk factor of secondary glaucoma after keratoprosthesis surgery.Five of these 15 patients received cyclocryotherapy after the surgery to control elevated IOP.BCVA decreased from 0.8 to 0.2,0.25 to light perception,0.3 to 0.1,0.2 to hand movement,and 0.25 to counting fingers,respectively.Conclusions Moroz keratoprosthesis caused glaucoma in only a small number of patients.Visual field,optic nerve appearance and IOP were the main diagnostic modalities after Moroz keratoprosthesis implantation.