不同前房深度急性闭角型青光眼持续高眼压患者的手术疗效分析

Surgical efficacy of persistent high intraocular pressure in acute angle-closure glaucoma patients with different anterior chamber thicknesses

目的探讨不同前房深度急性闭角型青光眼持续高眼压患者的手术疗效。方法选取2008年1月至2012年12月我院急性闭角型青光眼持续高眼压患者142例(142眼),根据术前前房深度将患者分为3组,A组45例行小梁切除术联合玻璃体抽吸;B组42例先行前房穿刺降眼压,再行小梁切除术;C组55例先给予药物等非手术治疗降眼压至低于30 mmHg(1 kPa=7.5 mmHg),再行小梁切除术。记录3组患者入院时、术后1周的眼压,同时观察术前及术后1个月视力,并观察3组患者相关并发症的发生情况。结果 A组、B组和C组患者入院眼压分别为(49.02±2.97)mmHg、(49.53±3.87)mmHg、(48.76±4.65)mmHg,组间差异均无统计学意义(均为P>0.05);术后1周眼压均较术前显著降低,差异均有统计学意义(均为P<0.05),其中A组低于B组和C组,差异均有统计学意义(均为P<0.05)。A组、B组和C组术前视力组间比较,差异均无统计学意义(均为P<0.05);3组患者术后1个月视力均显著增加(均为P<0.05);B组高于A组和C组(均为P<0.05),A组和C组相比,差异无统计学意义(P>0.05)。3组并发症发生率分别为13.3%、50.0%和11.4%,3组之间相比差异有统计学意义(χ2=18.87,P<0.01)。结论急性闭角型青光眼持续高眼压行小梁切除术时应同时抽吸玻璃体,提高患者预后。

Objective To analyses the surgical efficacy of persistent high in- traocular pressure in acute angle-closure glaucoma patients with different anterior chamber thicknesses. Methods A total of 142 acute angle-closure glaucoma patients （142 eyes）with persistent high intraocular pressure in our hospital were chosen, based on the preoperative chamber thickness, the patients were divided into three groups, 45 patients in group A were given trabeculectomy and vitreous aspiration, 42 patients in group B were given chamber puncture firstly to decrease the intraocular pressure, then performed the trabeculectomy, 55 patients in group C were given the drugs to decrease the intraocular pressure, then performed the trabeculectomy. The intraocular pressureat hospitalization and 1 week after operation of three groups were recorded, the preoperative and postoperative 1 week vis- ual acuity were observed, and the related complications of three groups were also observed. Results The intraocular pressure at hospitalization in group A, B, C were （ 49.02 ± 2.97 ） mmHg （ 1 kPa = 7.5 mmHg）, （ 49.53 ± 3.87 ） mmHg and （48.75 ± 4.55 ） mmHg, respectively, there was no statistical difference among three groups （ all P 〉 0.05 ）. The intraocular pressure at postoperative 1 week in group A, B, C had statistical differences compared with pre-operation （ all P 〈 0.05 ）, group A were lower than group B, group C （ all P 〈 0.05 ）, no statistical difference between group B and group C （P 〉 0.05 ）. There was no statistical difference in preoperative visual acuity among three groups （ all P 〉 0.05 ）. Compared with pre-operation, the postoperative visual acuity at 1 month were all increased （ all P 〈 0.05 ）. The visual acuity at postopera- tive I month in group B were higher than those in group A and group C （ all P 〈 0.05 ）, there was no statistical difference between group A and group C （P 〉 0.05）. The incidence of complication in group A, B, C were 13.3% , 50.0% and 1 1.4% , respectively, there was statistical difference among three groups （χ2 = 18.87, P 〈 0.01 ）. Conclusion The acute angle-closure glaucoma patients with persistent high intraocuiar pressure should perform the trabecuiectomy and vitreous aspiration to improve the prognosis.