青光眼术后发生恶性青光眼的临床分析  

Clinical analysis of malignant glaucoma after glaucoma surgery

作　　者：王敏[1] 谭浅[1] 江海波[1] 夏晓波[1] 王平宝[1] 蒋剑[1] 刘丹[1] 

机构地区：[1]中南大学湘雅医院眼科,长沙410008

出　　处：《中南大学学报（医学版）》2015年第5期543-548,共6页Journal of Central South University ：Medical Science

摘　　要：目的:通过回顾性收集原发性闭角型青光眼(primary angle-closure glaucoma,PACG)患者的临床资料,探讨恶性青光眼的危险因素、睫状体解剖形态特点、治疗方法以及预后。方法:回顾性收集2010年7月至2014年5月在中南大学湘雅医院确诊住院的PACG 1 183例(1 456眼)患者的临床资料,其中发生恶性青光眼患者共30例(38眼)。根据是否发生恶性青光眼分为PACG组(眼数1 418)和恶性青光眼组(眼数38);根据年龄段不同将PACG患者分为3~40岁组(眼数171)、41~70岁组(眼数1 016)、≥71岁组(眼数269);根据恶性青光眼治疗方式不同分为药物治疗组(眼数5)、晶体摘除组(眼数6)和玻璃体切除手术组(眼数27);根据恶性青光眼是否行玻璃体切除手术分为玻璃体切除手术组(眼数27)和非玻璃体切除手术组(眼数11)。记录患者年龄、性别、前房深度、眼轴长度、晶体厚度、治疗前后视力、治疗前后眼压、治疗方式、既往手术史等,同时记录使用超生生物显微镜测量的患者不同部位睫状体厚度(ciliary body thickness,CBT)、小梁睫状突的夹角(trabecular ciliary angle,TCA)和晶体直径。结果:恶性青光眼组男女比例为1:2,平均发病年龄[(51.87±12.92)岁]低于同期PACG组[(57.87±8.78)岁](P<0.05);PACG患者滤过手术后前3月,发生恶性青光眼的患者累计占85.7%;恶性青光眼组的晶体厚度为(4.33±0.67)mm,眼轴长度为(21.44±1.18)mm,前房深度为(2.12±0.41)mm,低于同期PACG组的晶体厚度[(4.81±0.50)mm]、眼轴长度[(22.17±0.97)mm]、前房深度[(2.49±0.48)mm](均P<0.05);恶性青光眼组CBT0,CBT1,CBTmax,TCA和晶体直径小于同期PACG组(均P<0.05)。结论:具有短眼轴、浅前房、薄晶体、薄睫状体、小梁睫状突夹角小、晶体直径小的女性PACG患者更易发生恶性青光眼;玻璃体切除术能显著降低眼压。Objective: To explore the risk factors, the ciliary body anatomy structures, the therapeutic methods and the prognosis for malignant glaucoma through retrospectively collecting the clinical data from primary angle-closure glaucoma(PACG) patients.Methods: Clinical data in 1 183 patients(1 456 eyes) with PACG were collected between July,2010 and May, 2014 from Xiangya Hospital, Central South University. Thirty patients(38 eyes) were diagnosed as malignant glaucoma. According to symptom, these patients were divided into a PACG group(1 418 eyes) and a malignant glaucoma group(38 eyes); according to age, they were divided into a 3–40 years old group(171 eyes), a 41–70 years old group(1 016 eyes) and a ≥71 years old group(269 eyes); according to therapeutic methods, they were divided into a drug therapy group(5 eyes), a lens extraction group(6 eyes) and a vitrectomy surgery group(27 eyes); according to the different method of surgery, they were divided into a vitrectomy group(27 eyes), a nonvitrectomy group(11 eyes). The age, sex, anterior chamber depth(ACD), axial length(AL), lens thickness(LT), visual acuity, intraocular pressure, therapeutic methods and surgery history were recorded. Meanwhile, the ciliary body thickness(CBT), trabecular ciliary process angle(TCA) and lens diameter were measured by ultrsound biomicroscopy(UBM).Results: Male and female ratio was 1:2 in the malignant glaucoma group. The average age [(51.87 ± 12.92) years] in the malignant glaucoma group was less than that in the PACG group [(57.87 ± 8.78) years](P<0.05). Malignant glaucoma was more likely to occur in the first 3 months after PACG trabeculectomy with a rate of 85.7%. The LT [(4.33±0.67) mm], AL[(21.44 ± 1.18) mm] and ACD [(2.12 ± 0.41) mm] in the malignant glaucoma group were less than those in the PACG group [(4.81 ± 0.50),(22.17 ± 0.97) and(2.49 ± 0.48) mm, respectively](all P<0.05). The CBT0, CBT1, CBTmax, TCA and lens diameter in the malignant glaucoma group were less than those in the PACG group(all P<0.05).Conclusio

关 键 词：恶性青光眼 睫状体厚度 危险因素 治疗 

分 类 号：R779.6[医药卫生—眼科]