青光眼滤过手术后持续低眼压35例临床分析

Clinical analysis on 35 patients with persistent hypotony after trabeculectomy

目的:探讨青光眼滤过手术后持续低眼压对眼组织结构和视功能的损害、发病机制及治疗原则。方法:对滤过手术后眼压值<10mmHg、持续时间2wk以上的患者35例(36眼)进行随访,并对眼压≤5mmHg和≤10mmHg 2组病例分别观察,观察项目为视力、眼压、角膜、滤过泡、前房、晶状体、眼底,随访时间6～36(平均10.2)mo。结果:视力下降9眼(眼压≤5mmHg 6眼,17%),角膜后弹力膜皱折6眼,白内障加重6 眼,黄斑区水肿3眼(均为眼压≤5mmHg,8%),其中1眼同时出现视网膜水肿,其中丝裂霉素C引起的低眼压占22%。低眼压引起的眼部并发症占本组病例的25%。结论:青光眼滤过手术后持续低眼压可引起视力下降,角膜和黄斑水肿等并发症,以眼压≤5mmHg眼为明显。药物和手术治疗可帮助提高眼压,改善视力。

AIM: To study the structural and functional impairment of persistent hypotony after trabeculectomy as well as its mechanism and treatment.· METHODS: A total of 35 cases (36 eyes) who had undergone trebculectomy (8 eyes with antimetabolites) and developed ocular hypotony (intraocular pressure≤10 mmHg, persistent time>2 weeks) were observed. They were divided into 2 groups according to their intraocular pressure (below 5 mmHg and 6-10mmHg). Visual acuity, cornea, chamber, lens and fundus were observed. The follow-up averaged 10.2 months (6-36 months).· RESULTS: Visual acuity decreased in 9 eyes (intraocular pressure≤5 mmHg in 6 eyes, 17%). There were 6 eyes with corneal edema, 6 eyes with cataract and 3 eyes with macular edema (intraocular pressure≤5 mmHg, 8%) among which retinal edema occurred in 1 eye. Trabeculectomy with antimetabolisms causing low pressure was calculated 22% and complications caused by hypotony were 25%.· CONCLUSION: Persistent hypotony after trabeculectomy can cause complications such as visual acuity decrease, corneal edema and macular edema which mainly occurred in cases whose intraocular pressures are below 5mmHg. Drug and operation can improve intraocular pressure.·