葡萄膜炎继发高眼压或青光眼的诊治分析

Diagnosis and treatment of ocular hypertension or secondary glaucoma in uveitis

目的:探讨葡萄膜炎患者继发眼压升高或青光眼的临床特点和诊治效果。方法:收集葡萄膜炎继发眼压升高或青光眼患者158例(206眼)的临床资料,分析其抗青光眼药物、激光或手术治疗效果。结果:158例患者中,男86例,女72例;平均年龄(46.5±17.8)岁。其中行抗青光眼药物治疗99眼(48.1%),因瞳孔闭锁或膜闭行YAG激光虹膜切除术54眼(26.2%),睫状体光凝术20眼(9.7%),小梁切除术16眼(7.8%),小梁切除术联合白内障超声乳化和人工晶体植入术7眼(3.4%),引流阀植入手术4眼(1.9%),有6眼(2.9%)行多次联合手术治疗。随访6~18个月,眼压控制较好者181眼,成功率为87.9%。末次随访发现矫正视力提高者171眼(83.0%),视力稳定者28眼(13.6%),视力恶化者7眼(3.4%)。结论:对于葡萄膜炎继发青光眼患者应积极控制炎症和降低眼压,局部滴眼药物、激光虹膜切除术、滤过手术或青光眼引流阀植入术可很好地控制眼压,挽救患者视力。

Objective： To explore the clinical features and efficacy of treatment for the patients with ocular hypertension or glaucoma secondary to uveitis. Methods： There were 158 cases（206 eyes） of patients with ocular hypertension or glaucoma during the treatment of uveitis. The efficacy of treatment with topical or systemic anti-glaucoma medications, laser or surgical management was analyzed. Results：Among the 158 patients, there were 86 males and 72 females. The mean age was（46.5±17.8）years old. There were 99 eyes（48.1%） treated with anti-glaucoma medications, 54 eyes（26.2%） with YAG laser iridotomy, 20 eyes（9.7%） with cyclophotocoagulation, 16 eyes（7.8%） with trabeculectomy, 7 eyes（3.4%） with combined trabeculectomy and phacoemulsification and intraocular lens implantation, 4 eyes（1.9%） with glaucoma drainage implant, and 6 eyes（2.9%） with multiple surgical treatments. The intraocular pressure of 181 eyes was well controlled and the successful rate was 87.9% after the 12-18 months follow-up. The corrected visual acuity of 171 eyes（83.0%） was improved at last visit, 28 eyes（13.6%） were stable and 7 eyes（3.4%） were deteriorated. Conclusion： For the patients with ocular hypertension or glaucoma secondary to uveitis, the aggressive anti-inflammation and the anti-glaucoma medications are essential. Tropical drops, laser iridotomy,trabeculectomy, cyclophotocoagulation or glaucoma drainage implants could control the intraocular pressure and minimize the visual impairment.