真性小眼球继发青光眼的治疗

The management of glaucoma in nanophthalmic patients

目的 :探讨真性小眼球继发青光眼的临床特征、治疗方法以及并发症的防治措施。方法 :回顾性分析了 17只真性小眼球继发青光眼的临床资料、治疗方法及病情转归。结果 :9例 17只眼 ,眼轴 14 3 6～ 19 3 3mm ;均合并有高度远视 ,屈光度 + 7 0 0～ + 16 0 0D。所有的患眼均有慢性闭角型青光眼的临床表现。其中 9只进展期的患眼经过激光虹膜手术联合药物治疗使青光眼得到控制 ;有 1只眼在就诊时已是绝对期 ,予以睫状体光凝以改善疼痛症状 ;另外 7只晚期患眼均接受了滤过手术 ,其中 3只在随诊期内出现了严重眼后节并发症导致失明。结论 :真性小眼球继发青光眼的治疗很复杂 ,在早期进行激光虹膜手术是治疗真性小眼球合并青光眼安全有效的方法 ,选择密闭性的眼内手术和预防性的涡静脉减压术、前巩膜切开术。

Objective:To study the clinical management and characteristics of glaucoma in nanophthalmos,as well as the prevention of its complications. Methods:Retrospectively,9 cases(17 eyes)of nanophthalmos with secondary glaucoma were studied. Results:The axial length of the eyes ranged 14 36-19 33mm,all of the cases combined with hyperopia which ranged +7 00-+16 00D.All the 17 eyes had the manifestation like chronic angle closure glaucoma.In 9 of 17 eyes in advancing stage of the glaucoma,the disease was controlled by the combination of laser iridotomy(4 of 9 eyes also underwent laser iridoplasty)and medications.1 eye was underwent ciliary photocoagulation.The other 7 eyes were underwent filtration surgery and 3 of them had permanent loss of vision caused by the postoperative complications occurred in posterior segment. Conclusions:The management of glaucoma in nanophthalmus is complicated.The laser iris surgery is safe and effective in early stage.Vortex vein decompression,Sclerolectomy or anterier sclerotomy may reduce the disastrous complications of filtration surgery.