复杂外伤性青光眼的联合手术治疗

The combined surgery for complicated traumatic glaucoma

目的 :观察复杂外伤性青光眼联合手术治疗的临床疗效 ,探讨手术方法及并发症。方法 :对 2 8例继发于钝挫伤、穿通伤的复杂外伤性青光眼行联合手术治疗 ,其中行晶状体摘除、前部玻璃体切除联合青光眼阀前房植入术 10例 ,保留晶状体、前部玻璃体切除联合青光眼阀前房植入术 3例 ,无晶状体眼行前部玻璃体切除、人造瞳孔术联合青光眼阀前房植入术 4例及睫状体扁平部植入术 5例 ,人工晶状体眼行可调整缝线小梁切除联合前部玻璃体切除术 4例 ,恶性青光眼行前房成形术 ,前部玻璃体切除联合青光阀扁平部植入术 2例 ,以上眼其中 7例同时行人工晶状体缝线固定术。结果 :术后随诊 9～ 4 0个月 ,平均 18 6个月 ,手术成功 (眼压 :6～ 2 1mmHg) 2 1只眼 (75 % )视力提高 15只眼 (5 3 5 % )。并发症 :早期低眼压 18例 ,脉络膜脱离 12例 ,眼压失控 7例 ,玻璃体出血 4例 ,引流管内口阻塞 5例 ,驱逐性出血 1例 ,视网膜脱离 1例。结论

Objective:To observe the clinical efficacy and complications of the combined surgery for advanced complicated traumatic glaucoma.Method:Combined surgeries were performed in 28 cases of complicated traumatic glaucoma which followed ocular contusion and laceration.Combined cataract extraction,vitrectomy and glaucoma valve implantation were performed in 10 cases.Anterior vitrectomy and glaucoma seton implatation with reserving lens in 3 cases.Anterior vitrectomy,pupiloplasty and glaucoma seton implantation in 9 cases.Removable suture trabeculectomy and anterior vitrectomy were performed in 4 cases of pseudophakic glaucoma.Goniosynechialysis combined anterior vitrectomy and glaucoma seton implantation were performed in 2 cases of malignent glaucoma.7 cases were received suture fixated IOL implantation.Results:All cases were followed up 18 6 months (9～40 months).Twenty one eyes (75%) were successful (IOP 6～21mmHg).The visual acuity of fifteen eyes (53 5%) were improved.Complications included early postoperative hypotony 18 eyes,choroidal detachment 12 eyes,expulsive haemorrhage 1 eye,obstruction of the tube tip 5 eyes,vitreous hemorrhage 4 eyes,retinal detachment 1 eye,increased IOP 7 eyes.Conclusion:The combined surgery for complicated traumatic glaucoma is effective.