窦小梁切除术后浅前房的致病原因及治疗方法研究

Causes of and treatment for shallow anterior chamber after trabeculectomy for glaucoma

目的探讨青光眼患者行复合式窦小梁切除术后发生浅前房的原因及处理方法。方法收集2009年1月至2013年12月期间平顶山市第一人民医院眼科213例(246只眼)窦小梁切除术后患者的临床资料,进行回顾性分析。所有患者均采用窦小梁切除术进行治疗,观察术后患者浅前房的发生情况,分析引发患者浅前房的原因,并进行治疗。结果本组患者术后共发生浅前房37例(43只眼),浅前房的发生率为17.48%。所有发生浅前房的患者中Ⅰ度浅前房者23例(27只眼),占62.79%;Ⅱ度浅前房者11例(12只眼),占27.91%;Ⅲ度浅前房者3例(3只眼),占6.98%。术后3 d内出现浅前房者32例(38只眼),占88.37%。3 d后出现浅前房者5例(5只眼),占11.63%,其中有2例(3只眼)患者是在拆除可调节缝线后出现浅前房的。因滤过过强导致浅前房者25例(30只眼),占69.77%;因结膜瓣渗漏导致浅前房者3例(3只眼),占6.98%;因脉络膜脱离导致浅前房者7例(7只眼),占16.28%;因恶性青光眼导致浅前房者2例(3只眼),占6.98%。通过保守治疗(包括使用棉垫加压、绷带加压、应用糖皮质激素及高渗剂对患者进行对症治疗)前房恢复者34例(40只眼),占93.02%;经保守治疗不能恢复需再次手术治疗者3例(3只眼),占6.98%。结论浅前房是窦小梁切除术后常见的并发症,经过保守治疗大部分患者可痊愈,正确分析浅前房发生的原因并及时处理是治疗的关键。

Objective To retrospectively analyze the causes and evaluate treatment efficacy of shallow anterior chamber after trabeculectomy in patients with glaucoma. Methods Medical records of 213 glaucoma patients （246 eyes） who underwent trabeculectomy in the Department of Ophthalmology,First People＇s Hospital of Pingdingshan City between 2009 and 2013 were accessed and reviewed. Data on the incidence, subtypes and severity of postoperative shallow anterior chamber were analyzed. Results Shallow anterior chamber occurred in 37 （ 17.5% ） patients （43 eyes） after trabeculectomy, including grade Ⅰ shallow anterior chamber in 23 （62.79%） patients （27 eyes） , grade II shallow anterior chamber in 11 （27.91% ） patients （ 12 eyes ） and grade Ⅲshallow anterior chamber in 3 （ 6. 98% ） patients （ 3 eyes ）. The complication occurred within the first 3 days after operation in 32 （88.37%） cases （38 eyes） and after postoperative day 3 in 5 （ 11.63% ） cases （ 5 eyes ） , of which 2 （ 3 eyes ） developed the complication after removal of the adjustable sutures. Overfiltration was the most predominant cause of the complication, accounting for 69.8% of the total shallow anterior chamber cases,followed by leakage of the conjunetival flap （3 cases, 3 eyes）, choroidal detachment （ 7 cases, 7 eyes）, malignant glaucoma （2 cases, 3 eyes）. Thirtyfour （93.02%） patients （40 eyes） were cured by conservative treatment, while 3 （6.98%） patients （3 eyes） needed surgeries to re-establish the anterior chamber. Conclusions Shallow anterior chamber is a common post-operative complication associated with the trabeculectomy procedure. The conservative treatment can effectively manage the complication in most patients if it is diagnosed early and treated timely.