急性闭角型青光眼高眼压状态下小梁切除术的远期疗效观察

Observation on the long-term efficacy of trabeculectomy in primary acute angle closure glaucoma with persisant high intraocular pressure

目的观察原发性急性闭角型青光眼患者高眼压状态下行复合式小梁切除术的远期疗效。方法回顾性研究。收集2008年1月至2015年12月惠州市中心人民医院收治的原发性急性闭角型青光眼大发作期患者26例(26眼)的临床资料。所有患者均行局部及全身降眼压治疗后眼压仍控制欠佳,对急性大发作眼行复合式小梁切除术。术后随访4~11年,观察远期疗效。结果随访期间均未见葡萄膜炎、前房积血或睫状体环阻塞性青光眼等严重并发症。入院眼压为(46.65±18.08)mmHg,出院眼压为(11.58±4.20)mmHg,末次随访眼压为(16.07±10.01)mmHg(1 mmHg=0.133 kPa)。末次随访时滤过泡Ⅰ级者18眼、Ⅱ级者1眼、Ⅲ级者7眼。滤过泡等级与末次随访眼压呈正相关(r=3.350,P=0.009)。随访期间视网膜神经纤维层厚度、视野指数及视野平均偏差逐渐降低(P<0.001)。结论复合式小梁切除术治疗持续性高眼压状态的急性闭角型青光眼患者有效且安全。

Objective To observe the long-term efficacy of combined trabeculectomy in primary acute angle closure glaucoma patients with persistant high intraocular pressure(IOP).Methods This was a retrospective study.The clinical data of 26 eyes of 26 cases with primary acute angle closure glaucoma from Jan.2008 to Dec.2015 in Huizhou Central People’s Hospital were collected.The IOP were not well controlled after local and systemic intraocular pressure reductive treatment.The eyes with acute attack were treated with combined trabeculectomy.These patients were followed up for 4 to 11 years,with the average of(5.34±2.13)years.The long-term efficacy were observed.Results No serious complication such as uveitis,hyphema or ciliary ring obstructive glaucoma were observed during follow-up visit.The IOP was(46.65±18.08)mmHg on admission,(11.58±4.20)mmHg on discharge and(16.07±10.01)mmHg at the last follow-up(1 mmHg=0.133 kPa).At the last follow-up visit,18 eyes occurred filtering bleb of grade Ⅰ,1 eye occurred filtering bleb of grade Ⅱ,and 7 eyes occurred filtering bleb of grade Ⅲ.There was a positive correlation between filtering bleb grade and intraocular pressure at the last follow-up(r=3.350,P=0.009).Retinal nerve fiber layer thickness,visual field index and mean defect decreased gradually during follow-up time(P<0.001).Conclusion Combined trabeculectomy is a effective and safe method for primary acute angle closure with persistant high IOP.