一期粘弹剂小管切开术治疗青少年开角型青光眼  

Primary viscocanalostomy for juvenile open-angle glaucoma

作　　者：韦斌[1] 付玲玲[1] 具尔提[2] 王星瑾[1] 

机构地区：[1]克拉玛依市中心医院眼科,克拉玛依834000 [2]新疆医科大学第一附属医院眼科

出　　处：《中国实用眼科杂志》2007年第10期1123-1125,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的评价一期粘弹剂小管切开术治疗药物难控性青少年开角型青光眼（juvenile open-angle glaucoma,JOAG）的有效性和安全性。方法研究17例JOAG患者的18眼,其JOAG患者经连续药物治疗未能有效控制病情,故一期行粘弹剂小管切开术,此前无相关手术史及激光治疗史。手术大体成功的判断标准为：术后眼内压（intraocular pressure,IOP）≤20mmHg,与用药和不用药时的基线IOP相比：IOP下降30%;无视盘凹陷进行性加深;无视野进行性受损。当再不需要药物治疗时,认为手术完全成功。未达到以上标准,需要手术矫正或进一步行前房穿刺的病例视为治疗失败。患者术后平均随访时间为（15±7.64）m。结果术前平均IOP为（29.56±12.72）mmHg,术后平均IOP为（16.08±9.19）mmHg,两者之间存在着显著的统计学差异（t=16.20,P〈0.001）。术后随访（12～18）m,15眼（83.3%）获得大体成功。10例（55.6%）为完全成功。3例（16.7%）失败。术中、术后均未发生严重的并发症,有2例（11.1%）自发出现了少量可吸收的前房出血。2例（11.1%）出现小梁网-狄氏膜的微小穿孔,另外1例（5.6%）因小梁网-狄氏膜穿孔伴虹膜脱出而需行虹膜周边切除术。结论对于药物难控性JOAG,一期粘弹剂小管切开术是一种安全有效降低IOP的治疗方法,是一种合理的、可代替传统术式的治疗方法。Objective To evaluate the efficacy and safety of primary viscocanalostomy for medically uncontrolled juvenile open-angle glaucoma（JOAG）.Methods The study included 18 eyes of 17 consecu- tive patients with medically uncontrolled JOAG who were treated by viscocanalostomy at one instituon. No surgical or laser procedure preceded viscocanalostomy. Surgical outcome was defined as an overall success by the following criteria： postoperative intraocular pressure（IOP） ≤ 20mmHg, and IOP reduction 30% compared with baseline values with or without medication; no visual field deteioration; no optic-disc progression. When medications were not required, success was defined as complete. Cases that did not fulfill the aforementioned criteria and cases in which a surgical revision or further goniopuncture was performed were defined as a failure. Follow-up was（15 ± 7.64） months after surgery. Results There were significant statistic difference between the mean preoperative intraocular pressure and the mean postoperative intaocular pressure（t= 16.20,P〈0.001）, the mean preoperative intaocular pressure was 29.56 ± 12.72mmHg; the mean postoperative intaocular pressure was 16.08 ±9.19mmHg. Twelve to eighteen months after operation, 15 eyes （83.3%） were considered an overall success. In 10 eyes （55.6%）, success was complete. 3 eyes （16.7%） were considered failures. No serious complications were documented either during or after operation. In 2 eyes （11.1%）,we documented a spontaneously reabsorbed micro-hyphema. Trabeculo-Descemet-membrane microperforation occurred in two eyes （11. 1%）. In one eye（5.6%）, Trabeculo-Descemet-membrane perforation occurred and was accompanied by iris prolapse that needed peripheral iridectomy. Conclusion Primary viscocanalostomy can efficiently and safety reduce intraocular pressure in cases of medically uncontrolled JOAG and provide a rational alternative to convetional surgical modalities.

关 键 词：一期粘弹剂小管切开术 青少年开角型青光眼 治疗 安全性 疗效 

分 类 号：R775.2[医药卫生—眼科]