恶性青光眼31例手术疗效研究

Surgical treatment of 31 cases of malignant glaucoma

目的:探讨白内障超声乳化摘除人工晶体植入、23G前部玻璃体切除、晶状体后囊膜切开术治疗恶性青光眼的临床效果。方法:收集经药物治疗无效的恶性青光眼患者共31例31只眼,男8例8眼,女23例23眼,年龄45~78岁,平均(63.1±11.8)岁,手术方式为:白内障超声乳化摘除人工晶体植入、23G前部玻璃体切除、晶状体后囊膜切开术,观察记录术前、术后1d、1周、2月、3月最佳矫正视力、眼压、前房深度、手术并发症,所有病例随访6月。结果:经手术治疗后,31只眼的最佳矫正视力由术前的(1.81±0.69)提升到术后的(0.81±0.11)(P<0.05);眼压由术前的(52.21±5.76)mmHg,下降到术后的(14.54±2.25)mmHg(P<0.05);前房深度由术前的(0.87±0.13)mm,加深到术后的(2.85±0.14)mm(P<0.05)。术后1天有2只眼发生脉络膜脱离,3只眼发生角膜水肿,1只眼发生玻璃体积血,经药物对症治疗随访6个月均痊愈。结论:白内障超声乳化摘除人工晶体植入、23G前部玻璃体切除、晶状体后囊膜切开术可提高恶性青光眼的成功率,其手术创伤小、手术时间短,提倡在临床治疗中普及。

Objetive:To investigate the clinical effect of phacoemulsification and intraocular lens implantation,23G anterior vitrectomy and posterior capsular capsulotomy in the treatment of malignant glaucoma.Methods:We collected Malignant glaucoma patients after drug treatment was invalid,31 cases 31 eyes including eight males and eight eyes,23 females and 23 eyes,age 45~78 years,mean(63.1±11.8)years,surgical methods:cataract phacoemulsification with intraocular lens implantation,23G anterior vitrectomy,posterior capsulotomy.Observation of preoperative,postoperative 1d,1w,2mo,3mo best corrected visual acuity,intraocular pressure,anterior chamber depth,surgical complications,all cases were followed up for 6 months,t-test was performed on all samples for independent samples.Results:After surgery,the best corrected visual acuity in 31 eyes increased from(1.81±0.69)preoperatively to(0.81±0.11)postoperatively(P<0.05),intraocular pressure decreased from(52.21±5.76)mmHg to(14.54±2.25)mmHg preoperatively(P<0.05),the depth of anterior chamber decreased from(0.87±0.13)mm preoperatively to(2.85±0.14)mm postoperatively(P<0.05),Choroidal detachment occurred in 2 eyes 1 day after surgery,corneal edema occurred in 3 eyes,vitreous hemorrhage occurred in 1 eye,the drug symptomatic treatment were followed up for 6 months were cured.Conclusion:Cataract phacoemulsification with intraocular lens implantation,23G anterior vitrectomy,posterior capsular capsulotomy can improve the success rate of malignant glaucoma,the surgical trauma is small,the operation time is short,advocate the popularity in clinical treatment.