微创玻璃体手术治疗恶性青光眼疗效观察

Treatment of malignant glaucoma with minimal invasive vitrectomy surgery

目的：观察应用25G微创玻璃体手术治疗恶性青光眼的临床效果。方法：回顾性分析2012-09/2013-10在我院就诊的恶性青光眼确诊患者11例13眼,所有患者均有明确的闭角型青光眼病史及小梁切除联合周边虹膜切除手术史。入院时平均最佳矫正视力（Log MAR视力）为0.70±0.13;平均眼压41.3±12.7mm Hg;UBM检查提示角膜及睫状体水肿,晶状体（或人工晶状体）及虹膜位置显著前移,平均前房深度0.69±0.17mm。所有患者均接受25G经睫状体扁平部前部玻璃体切除联合后囊膜切开手术治疗,其中,有晶状体眼7眼,术中联合白内障超声乳化并植入人工晶状体。结果：术后随访6-18（平均11.7±5.4）mo。末次随访平均最佳矫正视力提高至0.29±0.08;平均眼压为18.6±3.9mm Hg;术后1mo复查UBM提示睫状体水肿消退,人工晶状体及虹膜平面平坦,平均前房深度2.48±0.31mm。术后早期并发症包括角膜水肿、后弹力层皱褶、前房炎症反应、纤维素性渗出、虹膜局限性后粘连及低眼压（眼压≤5mm Hg）。1眼术后眼压升高至26.4mm Hg,需长期局部应用一种降眼压药物以控制眼压≤21mm Hg。无角膜内皮细胞失代偿、人工晶状体夹持、眼内出血、感染、眼压失控等严重并发症发生。结论：25G微创玻璃体手术可有效控制恶性青光眼患者的眼压,并减少传统玻璃体手术的相关并发症,联合白内障超声乳化手术可提高手术成功率及患者视功能。

AIM ：To evaluate the efficacy of 25G vitrectomy surgery for malignant glaucoma. METHODS： Thirteen eyes of 11 patients with malignant glaucoma who had a history of primary angle-closure glaucoma were analyzed retrospectively from September 2012 to October 2013 in our hospital. All patients had undergone a prior surgery of trebeculectomy combined with iridectomy. The pre-operative mean best corrected visual acuity （BCVA） in LogMAR was 0.70±0.13 and the mean intraocular pressure （lOP） was 41.3± 12.7mmHg. Corneal edema, ciliary body edema and very shallow anterior chamber with a mean value of 0. 69± 0. 17mm were showed by ultrasound biomicroscopy （UBM）. Anterior vitrectomy and posterior capsulotomy were performed with 25G vitrectomy system in all eyes. Seven phakic eyes underwent phacoimulsification combined IOL implantation surgery during vitrectomy. RESULTS： The patients were followed up for 6 - 18mo with an average of 11.7±5.4mo. BCVA at the last follow- up improved to 0.29±0.08 and the mean lOP was 18.6± 3.9mmHg. UBM results showed that ciliary body edema was eliminated, the iris was flattened and the anterior chamber was deepened with a mean depth of 2. 48 ± 0.31 mm at 1 mo after surgery. Postoperative complications included corneal edma, Descemet membrane folds, anterior chamber inflammation, fibrotic exudation, local iris posterior synechia and hypotony （IOP≤5mmHg）. One eye had high lOP of 26.4mmHg and required long-term topical antiglaucoma medication to control the IOP ≤ 21mmHg. No complications such as corneal endothelium decompensation, IOL capture,intraocular hemorrhage, infection and uncontrolled lOP were observed. CONCLUSION： 25G vitrectomy is safe and effective for treating malignant glaucoma, controls IOP and reduces complications associated with traditional vitrectomy. Combined vitrectomy with phacoemulsification may improve the success rate and visual function.