原发性闭角型青光眼滤过术后恶性青光眼的临床分析

Clinical analysis of malignant glaucoma after primary angle-closure glaucoma filtering surgery

目的探讨原发性闭角型青光眼滤过术后恶性青光眼的临床特点。方法选择2008年1月~2016年8月在我院治疗的1215例原发性闭角型青光眼患者的临床资料进行回顾性分析。所有患者均行原发性闭角型青光眼滤过术治疗。其中有16例发生术后恶性青光眼,给予药物治疗、手术治疗或者激光治疗。记录患者一般资料、临床资料,比较急性闭角型青光眼与慢性闭角型青光眼患者不同年龄段术后恶性青光眼发生率;比较术后恶性青光眼患者与未发生术后恶性青光眼患者术前中央前房深度、眼轴长度;比较不同发病时间患者药物治疗第3天平均眼压;统计患者治疗效果。结果女性的发病率较高,术后恶性青光眼患者年龄更大,术前中央前房深度浅,眼轴长度短,差异有统计学意义(P<0.05)。术后1周内发病患者药物治疗第3天平均眼压(28.35±6.11)mmHg,术后1周后发病者药物治疗第3天平均眼压(50.10±13.35)mmHg,差异有统计学意义(P<0.05)。结论高龄、女性、术前中央前房深度浅、眼轴长度短的患者更容易发生术后恶性青光眼,术后发病时间越晚药物治疗效果越差,临床上应积极给予药物治疗、手术治疗,以及时控制病情。

Objective To investigate the clinical characteristics of malignant glaucoma after primary angle closure glau- coma filtering surgery. Methods The clinical data of 1215 patients with primary angle-closure glaucoma treated in our hospital from January 2008 to August 2016 were retrospectively analyzed. All patients underwent primary angle closure glaucoma surgery.Among them,16 patients had postoperative malignant glaucoma and were given drug treatment, surgi- cal treatment or laser treatment. The general information and clinical data of patients were recorded. The incidence of postoperative malignant glaucoma in patients with acute angle-closure glaucoma and chronic angle-closure glaucoma in different ages was compared. Preoperative central anterior chamber depth and axial length between postoperative malignant glaucoma patients and non-postoperative malignant glaucoma patients were compared.The average intraocular pressure in patients with different onset time treated with drug therapy was compared. The treatment effect of patients was calculated. Results The incidence of female was high, and the patients with postoperative malignant glaucoma were older. And in patients with postoperative malignant glaucoma, the preoperative depth of the anterior chamber was shallower and the length of the axial length was shorter, and the difference was statistically significant （P〈0.05）. The average intraocular pressure was（28.35±6.11）mmHg on the third day after drug treatment in patients with onset within one week after surgery, and the average intraoeular pressure was（50.10±13.35）mmHg on the third day after drug treatment in patients with onset after postoperative 1 week. The difference between the two groups was statistically significant （P〈0.05）. Conclusion The patients with old age, female, shallow anterior chamber, and short axial length are more prone to post-operative malignant glaucoma. The later the onset of the disease, the worse the effect of drug treatment.Drug treatment and surgery should be actively given in clinical to control the condition in time.