原发性闭角型青光眼持续高眼压状态下的手术时机探讨  

Operative opportunity of primary angle-closure glaucoma with continuous high intraocular pressure

作　　者：王淑莉[1] 陈红玲[1] 黄宝玲[1] 张桂[1] 

机构地区：[1]漯河市中心医院眼科,河南省漯河市462000

出　　处：《眼科新进展》2011年第6期585-587,共3页Recent Advances in Ophthalmology

摘　　要：目的探讨持续高眼压状态下原发性闭角型青光眼小梁切除术的最佳手术时机。方法选取持续高眼压状态下原发性闭角型青光眼患者130例168眼,随机分为两组,试验组65例(84眼)患者行前房穿刺后3～7d行小梁切除术,对照组65例(84眼)患者行前房穿刺后即时行小梁切除术。术后眼压在8～21mmHg(1kPa=7.5mmHg)为手术成功的标准,所有患者术后随访6个月～1a,对比观察2组患者术后眼压、视力及并发症。结果试验组59例(77眼)患者手术成功,手术成功率为91.67%;对照组51例(68眼)患者手术成功,手术成功率为80.95%,2组手术成功率比较,差异有统计学意义(χ2=4.08,P<0.05)。术后早期的并发症:试验组角膜水肿5例(5眼),虹膜炎症反应13例(19眼);对照组角膜水肿32例(41眼),虹膜炎症反应60例(79眼),瞳孔大18例(18眼),前房出血4例(4眼),脉络膜脱离3例(3眼)。试验组并发症发生率明显低于对照组。结论高眼压持续状态下的小梁切除手术宜在前房穿刺术后3～7d进行,手术成功率更高,并发症更少。Objective To investigate the optimal opportunity of trabeculectomy for primary angle-closure glaucoma with continuous high intraocular pressure.MethodsAbout 130 cases（168 eyes）of primary angle-closure glaucoma with continuous high intraocular pressure were collected and randomly divided into 2 groups.The experimental group included 65 cases（84 eyes）,in which the trabeculectomy was performed at 3 days to 7 days after the puncture of anterior chamber,and the control group included 65 cases（84 eyes）,in which the surgery performed immediately after the puncture of anterior chamber.The standard of a successful surgery was intraocular pressure could be controlled between 8 mmHg to 21 mmHg.All patients had been followed up for 6 months to 1 year.The intraocular pressure,best visual acuity,complications were observed and compared between the two groups.ResultsThe surgery was successful in 59 cases（77 eyes）and the successful rate was 91.67% in experimental group.In control group,51 cases（68 eyes）were successful and the successful rate was 80.95%.There was statistically significant difference in the successful rate between the two groups（χ2= 4.08,P0.05）.At the early stage after surgery,corneal edema occurred in 5 cases（5 eyes）in experimental group and 32 cases（41 eyes）in control group.Iris inflammation occurred in 13 cases（19 eyes）in experimental group and 60 cases（79 eyes）in control group.There were 18 cases（18 eyes）with mydriasis,4 cases（4 eyes）showed hyphema,and 3 cases（3 eyes）indicated choroidal detachment in control group.The incidence of complication was obvious lower in experimental group than in control group.ConclusionsIt is reasonable and optimal to operate trabeculectomy at 3 days to 7 days after the puncture of anterior chamber for patients with continuous high intraocular pressure,which can improve the successful rate and decrease the postoperative complications.

关 键 词：青光眼 持续高眼压 小梁切除术 前房穿刺 

分 类 号：R775[医药卫生—眼科]