改良小梁切除术治疗伴有高眼压及大瞳孔的急性房角关闭  

Modified trabeculectomy in primary acute angle-closure with high intraocular pressure and extremely dilated pupil

作　　者：林明楷[1] 葛坚[1] 凌运兰[1] 卓业鸿[1] 高新博[1] 李作红[1] 

机构地区：[1]中山大学中山眼科中心,广州510060

出　　处：《中华显微外科杂志》2011年第4期294-296,共3页Chinese Journal of Microsurgery

基　　金：基金项目：广东省自然科学基金资助项目（05001713）;广东省科技计划项目（20118031800176）

摘　　要：目的评价改良小梁切除术治疗伴有高眼压及大瞳孔的急性房角关闭的临床疗效。，方法收集2005年1月至2009年3月中山大学中山眼科中心青光眼专业实施改良小梁切除术治疗伴有高眼压及大瞳孔的急性房角关闭21例（21眼）的临床资料，对术后并发症及手术前后的眼压、视力、瞳孔等进行统计分析。结果术前眼压（48．25±3．14）mmHg，平均用降眼压药种类3．35种，明显高于出院时眼压（10．47±1．15）mmHg（t=11．4573，P〈0．01）及术后3个月眼压（13．86±0．93）mmHg（t=11．2641，P〈0．01）。出院视力（0．09±0．05）与术前视力（0．11±0．06）差异无统计学意义（t=0．8702，P=0．3913），术后3个月视力（0．21±0．04）则稍好于术前（t=-2．7907，P=0．0112）。术前瞳孔垂直径（5．81±0．23）mm与出院时瞳孔垂直径（5．92±0．21）mm差异无统计学意义（t=-1．5013，P=0．1672）。无严重并发症发生。结论改良小梁切除术是治疗伴有高眼压及大瞳孑L的急性房角关闭的有效方法，术中分次放房水、巩膜瓣调节缝线、术毕形成前房等措施可有效减少严重并发症的发生。Objective To determined the outcome of modified trabeculecotomy （with paracentesis, mitomycin C, scleral flap adjustable suture and formation of anterior chamber at the end of the surgery） in the management of primary acute angle-closure （PAAC） with high intraocular pressure （IOP） and extremely dilated pupil. Methods Twenty-one eyes of 21 successive cases with PAAC with high IOP （IOP 〉 30 mmHg） and large pupil （maximum vertical diameter 〉 5 mm） were evaluated prospectively. They underwent modified trabeculecotomy between January 2005 and March 2009. The operative success was defined as IOP ≤20 mmHg （＋ medical therapy） without the necessity of further surgery for glaucoma. Results Success was achieved in all of the eyes （100%） at the postoperative first week. The mean preoperative IOP was （48.25 ±3.14） mmHg under a mean number of 3.35 antiglaucomotous medications, but it reduced to （10.47 ±1.15,P 〈 0.01） mmHg without medication at the first week, （13.86 ± 0.93,P 〈 0.01） mmHg at postoperative 3rd month respectively. Only 1 eye needed 1 kind of antiglaucomotous eye drop from the 2nd month postoperatively. The mean vertical diameter of pupils was （5.81±0.23） mm preoperatively, （5.92 ± 0.21 ）mm at the first week（P 〉 0.05）. No case received section iridectomy. No serious complication was ob- served. Conclusions Modified trabeculectomy provides reduction of IOP and protection of pupil in cases with PAAC with high IOP and large pupil, and the procedures such as releasing aqueous humor gradually, appliance of scleral flap adjustable sutures and formation of anterior chamber at the end of the surgery can ef- fectively reduce the risk of serious complications.

关 键 词：急性房角关闭 高眼压 大瞳孔 小梁切除术 显微手术 

分 类 号：R779.6[医药卫生—眼科]