虹膜周边前后节沟通术在恶性青光眼患者治疗中的应用

Effect of Zonulo-hyaloido-vitrectomy in treatment of malignant glaucoma

目的评价虹膜周边前后节沟通术治疗恶性青光眼及具有恶性青光眼倾向的原发性闭角型青光眼患者的临床效果。方法收集我院2013年5月至2018年4月行虹膜周边前后节沟通术的88例(92眼)恶性青光眼及具有恶性青光眼倾向的原发性闭角型青光眼患者资料。观察手术前后眼压、最佳矫正视力、中央及周边前房深度及房角的变化情况,术后随访(25.7±13.5)个月。结果恶性青光眼患者术前药物控制下眼压(34.27±12.95)mmHg(1 kPa=7.5 mmHg),术后第7天及末次随访眼压分别为(12.94±3.12)mmHg、(13.17±4.54)mmHg,与术前相比,差异均有统计学意义(均为P<0.01)。末次随访最佳矫正视力较术前明显提高(P<0.05)。有恶性青光眼倾向的原发性闭角型青光眼患者术前患眼药物控制下眼压(20.50±7.41)mmHg,术后第7天及末次随访眼压分别为(13.92±4.39)mmHg、(15.25±4.54)mmHg,与术前相比,差异均有统计学意义(均为P<0.01)。术后最佳矫正视力与术前相比差异无统计学意义(P>0.05)。所有患者中央前房深度术前为(1.67±0.33)mm,术后1个月为(3.35±0.35)mm,差异有统计学意义(P<0.01)。患者术前周边前房深度均<1/2 CT,术后89眼周边前房深度≥1 CT。术前72眼房角关闭范围>180°,术后房角完全开放38眼。结论虹膜周边前后节沟通术可有效治疗恶性青光眼及具有恶性青光眼倾向的原发性闭角型青光眼患者。

Objective To evaluate the clinical efficacy of zonulo-hyaloido-vitrectomy for patients having malignant glaucoma or primary angle-closure glaucoma(PACG)with a tendency to malignant glaucoma.Methods The study included 92 eyes of 88 patients who were diagnosed with malignant glaucoma or PACG with a tendency to malignant glaucoma,and underwent zonulo-hyaloido-vitrectomy in our hospital from May 2013 to April 2018.The changes of intraocular pressure(IOP),best corrected visual acuity(BCVA),central anterior chamber depth,peripheral anterior chamber(PAC)depth and anterior chamber angle were observed before and after operation.The average follow-up time was(25.7±13.5)months.Results For patients with malignant glaucoma,mean IOP were(34.27±12.95)mmHg(1 kPa=7.5 mmHg)before operation,and had statistical differences with(12.94±3.12)mmHg 7 days after operation and(13.17±4.54)mmHg at the last follow-up(all P<0.01).BCVA at the last follow-up significantly improved(P<0.05).For patients diagnosed as PACG with a tendency to malignant glaucoma,mean IOP were(20.50±7.41)mmHg before operation,and had statistical differences with(13.92±4.39)mmHg 7 days after operation and(15.25±4.54)mmHg at the last follow-up(all P<0.01).There was no significant difference in BCVA before and after operation(P>0.05).For all patients,the average central anterior chamber depth was(1.67±0.33)mm before operation and(3.35±0.35)mm one month after operation,and statistical difference was found(P<0.01).The PAC depth was<1/2 CT for all patients before operation,and≥1 CT for 89 eyes after operation.There were 72 eyes whose preoperative angle-closure range were>180°,and there were 38 eyes whose anterior chamber angle were fully opened after operation.Conclusion Zonulo-hyaloido-vitrectomy is an effective way for the treatment of malignant glaucoma and PACG with a tendency to malignant glaucoma.