三种途径植入房水引流物治疗难治性青光眼的疗效观察  

Glaucoma seton implantation surgery via different pathways for complicated glaucoma

作　　者：王宁利[1] 高汝龙[1] 唐仕波[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,广州510060

出　　处：《中华眼科杂志》2001年第6期409-413,共5页Chinese Journal of Ophthalmology

摘　　要：目的　观察 3种途径 (经角膜缘植入前房、经角膜缘后植入后房及经睫状体平坦部植入玻璃体腔 )植入房水引流物治疗难治性青光眼的效果。方法　对 99例 (99只眼 )难治性青光眼患者行房水引流物植入术。根据植入途径分为 3组 :经角膜缘植入前房组 5 8例 (5 8只眼 ) ,经角膜缘后植入后房组 16例 (16只眼 ) ,经睫状体平坦部植入玻璃体腔组 2 5例 (2 5只眼 )。结果　术后随访 6～ 34个月 ,平均 19 6个月。引流物经角膜缘植入前房组眼压 <2 1mmHg(1mmHg =0 133kPa)者 46例(79 3%) ,其中需加用局部降眼压药物者 6例 (10 3%) ;经角膜缘后植入后房组眼压 <2 1mmHg者 12例 (75 0 %) ,其中需加用局部降眼压药物者 1例 (6 2 %) ;经睫状体平坦部植入玻璃体腔组眼压 <2 1mmHg者 13例 (5 2 0 %) ,其中需加用局部降眼压药物者 3例 (12 0 %)。 3组的手术成功率差异有显著性 (χ2 =6 5 2 5 ,P <0 0 5 )。经睫状体平坦部植入玻璃体腔组成功率较低。但经除外新生血管性青光眼患者后 ,3组的手术成功率分别为 83 3%、75 0 %及 5 8 8%,差异无显著性 (χ2 =4 2 31,P >0 0 5 )。结论　通过 3种途径植入房水引流物治疗难治性青光眼的效果基本相同 ,可根据患者具体情况选择合适的植入途径。Objective To evaluate the effectiveness of glaucoma seton implantation surgeries via three different pathways for complicated glaucoma. Methods Ninety-nine cases (99 eyes) with complicated glaucoma having undergone glaucoma seton implantation surgeries were divided into three groups. Fifty-eight cases were included (58 eyes) in the group with anterior chamber implantation (AC group), 16 cases (16 eyes) were in the group with posterior chamber implantation (PC group) and 25 cases (25 eyes) were in the group with vitreous cavity implantation (VC group). Results The follow-up ranged from 6 to 34 months (mean 19.6 months). In the AC group, the postoperative intraocular pressure (IOP) of 40 cases (69.0%) was <21 mm Hg (1 mm Hg =0.133 kPa) without using any pressure-lowering agents. The postoperative IOP of 6 cases (10.3%) was <21 mm Hg with pressure-lowering agents. Patients with IOP controlled <21 mm Hg were altogether 46 cases (79.3%). The IOP of 11 cases (68.8%) in the PC group was controlled without agents and another 1 case (6.2%) was controlled with medications. Therefore, the total success rate was 75.0% (12 cases). The corresponding rates for the VC group were 10 cases (40.0%), 3 cases (12.0%) and 13 cases (52.0%) respectively. Statistical significant difference (χ 2 = 6.525, P=0.038) was found in the success rates among these 3 groups. But if we excluded cases with neovascular glaucoma, no statistical difference (χ 2 =4.231, P =0.121) was found of the success rates among these 3 groups. Conclusion No influence on surgical effectiveness was found among glaucoma seton implantation surgeries via different pathways for complicated glaucoma.

关 键 词：房水引流植入物 难治性青光眼 治疗途径 

分 类 号：R775[医药卫生—眼科]