难治性青光眼中复杂病例的手术治疗  

Surgical treatment of complicated cases of refractory glaucoma

作　　者：王宁利[1] 高汝龙[1] 唐仕波[1] 欧阳洁[1] 吴河坪[1] 曾明兵[1] 

机构地区：[1]中山医科大学中山眼科中心,510060

出　　处：《中国实用眼科杂志》2000年第6期346-349,共4页Chinese Journal of Practical Ophthalmology

摘　　要：探讨玻璃体切割经睫状体扁平部植入房水引流物联合手术 ,治疗难治性青光眼复杂病例的可能性 ,为这类青光眼的治疗提供新的手段。方法 :对 10例由于多次眼前段手术眼前部球结膜及巩膜组织结构破坏或由于手术、炎症及其他原因导致扁平前房 ,眼前段解剖关系已改变 ,从而失去行传统前路抗青光眼手术机会的复杂性青光眼进行了针对性的联合手术治疗。其中 4例前房消失 ,晶体混浊者接受了晶体咬切、玻璃体切除联合行扁平部房水引流物植入术。2例合并有玻璃体出血者接受了玻璃体切除联合行扁平部房水引流物植入术。3例既往已行晶体摘除及玻璃体切除者则单纯行扁平部房水引流物植入术 ,术后追踪时间为 6～ 2 1月。结果 :术后最后二次的复查结果显示 ,10例病例中有 6例在未用任何抗青光眼药物条件下眼压控制在 2 1mm Hg (2 .793k Pa)以下。另 2例在加用局部抗青光眼药物条件下眼压控制在 2 1mm Hg以下。 8例术后视力保持稳定或提高 ,1例由于迟发性脉络膜上腔出血 ,1例由于牵引性视网膜脱离视力下降或丧失。结论 :玻璃体切除联合经睫状体扁平部房水引流物植入术为难治性青光眼中复杂病例的手术治疗提供了可能。根据患者具体情况针对性的设计及实施联合手术 。Objective:To evaluate the possibility and effectiveness of treatment of complicated glaucoma with combined operation to provide new technique for the treatment of glaucoma.Methods:10 cases of complicated glaucoma,who lost the opportunity to undergo classic filtering surgery due to the anatomic structure deteriorated of anterior ocular segment and anterior chamber shallow or disappearance resulted from multiple surgical interference and inflammation were underwent a vitrectomy combined pars plana glaucoma seton implantation.4 cases with cataract and flat anterior chamber underwent lensectomy,vitrectom and pars plana glaucoma seton implantation,2 cases with vitreous haemorrhage underwent vitrectomy and pars plana glaucoma seton implantation,3 cases who had been performed lensectomy and vitrectomy underwent pars plana glaucoma seton implantation.All cases were followed up for 6～21 months.Results:In 6 of the 10 cases,the postoperative IOP were under 21 mmHg(2 79kPa)without any antiglaucoma drugs.In 2 of the 10 cases,the postoperative IOP were under 21 mmHg with topical antiglaucoma drugs.Vision remained stable or improve in 8 patients but deteriorated in one due to delay onset choriodal haemorrhage and in another due to progressive traction retina detachment.Conclusion:Vitrectomy combined with pars plana glaucoma seton implantation provide the possibility of surgical treatment for complicated glaucoma.Combined operation that designed and performed according to the idiographic conditions of patient provide new technique for the complicated glaucoma.

关 键 词：现代房水引流物植入术 玻璃体切除 复杂性青光眼 

分 类 号：R775.05[医药卫生—眼科]