改良显微小梁切除术治疗葡萄膜炎继发性青光眼  

Effect of modified trabeculectomy on the treatment of glaucoma secondary in uveitis

作　　者：刘杏[1] 肖辉[1] 黄晶晶[1] 钟毅敏[1] 陈晓蓓[1] 曹丹[1] 

机构地区：[1]中山大学中山眼科中心,眼科学国家重点实验室,广州510060

出　　处：《中华显微外科杂志》2009年第3期202-204,共3页Chinese Journal of Microsurgery

基　　金：广东省医学科研项目（B2007066）

摘　　要：目的探讨小梁切除术中采用虹膜节段切除联合应用丝裂霉素C（MMC）及粘弹剂治疗葡萄膜炎继发性青光跟的临床疗效。方法术中根据患者的年龄、炎症和结膜Tenon囊情况选用不同浓度的MMC（0．25～0．33mg／ml），应用粘弹剂分离虹膜前后粘连和瞳孔区机化膜并剪除机化膜，节段切除虹膜，可控缝线缝合巩膜瓣。观察手术前后视力、眼压、炎症和术后并发症情况。结果葡萄膜炎继发性青光眼共38例42眼，平均随访时间（12．01±3．56）月。术后末次复查与术前比较，视力提高14眼，不变28眼；前房炎症消失35眼，减轻7眼；平均眼压（15．20±4．64）mmHg与术前（38．37±12．93）mmHg比较差异有统计学意义（t=8．255，P=0．000）。手术总成功率92．9％，无严重并发症发生。结论小梁切除术术中联合应用MMC、粘弹剂、虹膜前后粘连分离、虹膜节段切除及可控缝线技术能够提高较严重葡萄膜炎继发性青光眼的手术成功率．减少手术并发症及术后炎症反应．减少葡萄膜炎复发。Objective To investigate the effect of trabecnlectomy combined with segmental iridectomy, mitomycin C （MMC） and viscoelastic agents usage on the treatment of glaucoma secondary in uveitis. Methods According to the age, degree of inflammation and the condition of Tenon capsule of patients, different concentration of MMC （0.25-0.33 mg/ml） was used during the operation, with separation of the anterior and posterior synechia, resection of pupillary organization membrane using viscoelastic agents. Segmental iridectomy and releasable sutures were also performed on the patients. The visual acuity of preoperation and postoperation, intraocular pressure, inflammation and the complication were record. Results Forty-two eyes of 38 cases with glaucoma secondary in uveitis were studied, the mean follow-up time was （12.01 ± 3.56） months. The postoperative visual acuity improved in 14 eyes, didn＇t change in 28 eyes. The postoperative inflammation of anterior chamber disappeared in 35 eyes, relieved in 7 eyes. And the average postoperative intraocular pressure （15.20 ± 4.64） mmHg was significantly lower than the preoperative intraocular pressure （38.37 ± 12.93） mmHg （t = 8.255, P = 0.000）. The total success rate was 92.9%. There were no severe complication. Conclusion Trabeculectomy combined with MMC, viscoelastic agents usage, separation of anterior and posterior synechia, segmental iridectomy and releasable suture could increase the success rate of operation on pa tients with glaucoma secondary in uveitis, decrease the complication and inflammation reaction of operation, and the recurrence of uveitis.

关 键 词：葡萄膜炎 青光眼 小梁切除术 显微手术 

分 类 号：R779.6[医药卫生—眼科] R775.3[医药卫生—临床医学]