恶性青光眼的临床分析  

Retrospective clinical analysis of 118 cases with malignant glaucoma

作　　者：张为中[1] 黄荔[1] 马健[1] 李晓柠[1] 黄晶晶[1] 葛坚[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：《中华眼科杂志》2013年第2期126-129,共4页Chinese Journal of Ophthalmology

摘　　要：目的探讨恶性青光眼的临床特征。方法病例系列研究。收集2005年4月至2010年3月间确诊住院的101例（118只眼）恶性青光眼患者临床资料和出院后2—6个月的随访资料，进行回顾性分析。包括患者性别、年龄、原发病、眼轴、治疗方法、手术并发症、治疗前后和随访期视力、眼压、前房深度等数据。结果101例（118只眼）恶性青光眼患者中，男性32例，女性69例，男女患者比例1．0：2．2；平均发病年龄（49．67±13．69）岁，低于同期住院的原发性闭角型青光眼（PACG）患者的平均发病年龄（62．34±11．139）岁。61例（60只眼）恶性青光眼的眼轴长度为（21．80±1．55）mm，低于PACG患者的眼轴长度（22．05±0．97）mm和正常值（23．00±0．89）mm。恶性青光眼主要发生于PACG抗青光眼术后，55．4％的患者在术后1周内发病。93％的患者需要在药物治疗基础上联合手术治疗。玻璃体腔抽吸联合前房成形术和晶状体摘除联合前段玻璃体切除术是最常见的治疗术式，后者视力提高和眼压下降明显，前房加深显著。前房成形术治疗失败的患者年龄为（43．7±4．8）岁，明显低于治疗成功的患者（53．7±12．6）岁（P〈0．05）。结论恶性青光眼几乎均为继发性，主要发生于PACG术后，低龄患者易发，女性患者多见。阿托品是首选的治疗药物。晶状体摘除联合前段玻璃体切除术优于玻璃体抽吸联合前房成形术。年轻恶性青光眼患者应考虑选择晶状体摘除加前段玻璃体切除术而不是玻璃体抽吸前房成形术。Objective To study the clinical characteristics and pathogenesis of malignant glaucoma in a 5-year retrospective analysis in Zhongshan Ophthalmic Center （ZOC）. Methods Medical records of 5- year malignant glaucoma patients in Zbongshan Ophthalmic Center were reviewed retrospectively. Patients＇ age, gender, original disease, duration before attack, axial length and the change of depth of anterior chamber, intraocular pressure and visual acuity before and after therapy and at final follow-up were checked and analyzed. Results One hundred and eighteen cases of malignant glaucoma were hospitalized in ZOC from April 2005 to March 2010, accounts for 2. 17% of PACG patients. Average age of malignant glaucoma patients was lower than that of PACG patients. The mean axial length of malignant glaucoma patients was shorter than that of Chinese population. Malignant glaucoma attacked between 1 day and 4. 5 years after surgery. Ninty-three percent patients required medication and surgeries. Lens extraction and anterior vitreetomy were more effective than anterior chamber reforming combined with vitreous aspiration. The mean age of failed patient with vitreous cavity suction combined with anterior chamber angioplasty surgery was （43.7 ± 4.8 ） years, and was significantly younger than succeed patients, （53.7 ± 12.6 ） years （ P 〈 0.05 ）. Conclusions Malignant glaucoma are iatrogenic and nine tenths secondary to surgeries of PACG patients. Topical application of atropine is the first choice of medication. Lens extraction combined with anterior vitrectomy has more privileges, however, is not commended especially for younger patients.

关 键 词：青光眼 闭角型 疾病恶化 玻璃体切除术 年龄因素 性别因素 

分 类 号：R779.6[医药卫生—眼科]