原发性急性闭角型青光眼持续性高眼压睫状体光凝后行小梁切除术的疗效观察  

Clinical effect of trabeculectomy after cyclophotocoagulation on acute angle-closure glaucoma-induced durative high intraocular hypertension

作　　者：李维娜[1] 张育谋[1] 李学喜[1] 魏锐利[2] 

机构地区：[1]解放军第180医院眼科,福建省泉州市362000 [2]第二军医大学附属长征医院眼科,上海市200003

出　　处：《眼科新进展》2013年第5期472-474,共3页Recent Advances in Ophthalmology

摘　　要：目的探讨原发性急性闭角型青光眼持续性高眼压睫状体光凝后再行小梁切除术的临床疗效。方法选择原发性急性闭角型青光眼持续性高眼压经巩膜二极管激光睫状体光凝(transscleral diode laser cyclophotocoagulation,TDCP)后因眼压再次升高行小梁切除术的患者14例(14眼)。比较光凝前、光凝后1周、小梁切除术前、术后1周、3个月以及1a的眼压和视力,并记录患者症状和术中、术后并发症。结果光凝前、光凝后1周、小梁切除术前、术后1周、3个月以及1a的眼压分别为(54.73±7.55)mmHg(1kPa=7.5mmHg)、(15.30±9.41)mmHg、(41.91±10.80)mmHg、(11.70±5.99)mmHg、(14.83±2.44)mmHg、(16.36±4.22)mmHg;视力分别为0.1447±0.2241、0.1929±0.1476、0.2525±0.2032、0.2536±0.1843、0.2439±0.1785、0.2254±0.1885。光凝后1周、小梁切除术前与光凝前眼压相比,差异有统计学意义(P<0.05)。小梁切除术后1周、3个月和1a与小梁切除术前相比,眼压下降,差异有统计学意义(均为P<0.05)。小梁切除术后1周、3个月和1a之间眼压两两比较,差异无统计学意义(均为P>0.05)。各时间点之间的视力比较,差异均无统计学意义(F=0.718,P=0.612)。光凝后当天诉眼痛者2例,予止痛药口服后缓解,之后所有患者均未再诉患眼剧烈疼痛或严重的眼部不适。光凝后2例患者有持续性前房闪辉超过1个月。小梁切除术后3例患者未见虹膜周边切口。结论原发性急性闭角型青光眼持续性高眼压可首选TDCP治疗,光凝后视功能可以维持不变或升高,眼压若再次升高可行小梁切除术,TDCP对后续的小梁切除术无不良影响。Objective To evaluate the clinical effect of trabeculectomy after cyclophotocoagulation on primary acute angle-closure glaucoma-induced durative high intraocular hypertension （IOP）. Methods Fourteen patients （ 14 eyes ） with durative high IOP induced by acute angle-closure glaucoma that had received trabeculectomy because of the even higher IOP after receiving transscleral diode laser cyclophotocoagulation（TDCP） were recruited. IOP and visual acuity were recorded at a total of six pointsin-time（before TDCP and 1 week after TDCP,before and 1 week,3 months,and 1 year after trabeculectomy） and analyzed. Patients＇ symptoms,intraoperative and postoperative complications were also recorded. Results IOP at the six points-in-time were （54.73±7.55） mmHg（ 1 kPa =7.5 mmHg）, （ 15.30 ±9.41 ） mmHg, （41.91 ± 10.80） mmHg, （ 11.70 ± 5.99 ） mmHg, （ 14.83 ± 2.44 ） mmHg, （ 16.36 ± 4.22 ） mmHg, respectively. Visual acuity were 0. 144 7±0. 224 1,0. 192 9±0. 147 6,0.252 5±0. 203 2,0. 253 6 ± 0. 184 3,0.243 9 ± 0.178 5,0.225 4 ± 0. 188 5 ,respectively. Compared IOP before TDLP with that at 1 st week after TDCP and before trabecuiectomy, differences were of statistical significance （ both P 〈 0.05 ）. lOP before trabeculectomy was significantly lower than that at the three points-in-time after trabeculectomy （ all P 〈 0.05 ）. There was no significant difference among IOP at the three points-in-time after trabeculectomy （all P 〉 0.05）. No significant difference among visual acuity at the six points-in-time was found（F =0.718 ,P=O. 612）. Only 2 cases were reported acute ocular pain after TDCP, and the symptoms were allayed after medication of painkiller. After that no acute ocular pain or serious eye discomfort was found. Two cases had durative flare in anterior chamber for more than I month. No incisions around iris was found in 3 cases after trabeculectomy. Conclusion TDCP is the first choice to treat acute angle-closure glaucoma-induced durative high intraocu

关 键 词：二极管激光 睫状体光凝 闭角型青光眼 小梁切除术 

分 类 号：R[医药卫生]