外伤性房角后退性青光眼手术方法选择及其疗效研究  

Surgical methods and efficacy studies on traumatic angle recession glaucoma

作　　者：张娇[1] 袁军[1] 白婷婷[1] 汪晓玲[1] 

机构地区：[1]中国四川省广元市第二人民医院眼科,628017

出　　处：《国际眼科杂志》2015年第9期1587-1589,共3页International Eye Science

摘　　要：目的:探讨外伤性房角后退性青光眼手术方法选择及其疗效。方法:回顾性探讨我院2008-01/2013-12应用三种不同手术方式治疗的外伤性房角后退性青光眼患者80例80眼的临床资料,分析手术时机及手术方式的选择。其中发病时间为伤后1mo^2a、术前眼压25~<30mm Hg、房角后退范围≤180°、视盘C/D≥0.6的66例66眼选择常规小梁切除术;发病时间为伤后>2~10a、术前眼压30~39mm Hg、房角后退范围>180°、视盘C/D>0.6~<0.8的11例11眼选择复合式小梁切除术;发病时间为伤后10a以上、术前眼压>39~50mm Hg、房角后退范围>180°、视盘C/D=0.8~1.0的3例3眼选择青光眼引流阀植入术。结果:常规小梁切除、复合式小梁切除及青光眼引流阀植入三组患者术后眼压均下降至正常范围(t=62.16,P<0.01;t=20.39,P<0.01;t=6.78,P<0.01),青光眼症状消失,视野检查无进行性缩小。常规小梁切除和复合式小梁切除组视力较前略有提高。青光眼引流阀植入组视力无明显改变。常规小梁切除组术后有效滤过泡65例(98%),复合式小梁切除组有效滤过泡9例(82%)。青光眼引流阀植入组3例有效滤过泡均形成好。结论:对于药物治疗无效的外伤性房角后退性青光眼患者针对发病时间、房角后退范围、眼压情况选择不同的手术方式可以有效降低眼压,提高视力,避免视功能的进一步损害。AIM： To discuss the operation manner and efficacy of traumatic angle recession glaucoma. METHODS： The clinical data of 80 patients （80 eyes） who was treated traumatic angle recession glaucoma by three different operation manners between January 2008 and December 2013 retrospectively. Of them, 66 eyes of 66 patients whose onset time after injury was lrno - 2a, preoperative lOP was 25 - 〈 30mmHg, angle recession range ≤180°, optic C/D ≥0.6 received trabeculectomy; 11 eyes of 11 patients whose onset time after injury was 〉2 - 10a, preoperative lOP was 30 -39mmHg, angle recession range 〉180°, the disc C/D = 0. 6 - 〈0. 8 underwent compound trabeculectomy; 3 eyes of 3 patients whose onset time after injury was 〉 10a, preoperative lOP 39 - 50mmHg, angle recession range 〉180°, the disc C/D =0.8 - 1.0 selected Ahmed glaucoma valve implantation. RESULTS： lOP of all patients in three groups decreased to the normal range after operation （ t=62.16, P〈0.01 ; t= 20.39, P〈0.01; t=6.78, P〈0.01）, without glaucoma symptoms and progressive visual field narrowing. Visual acuity in trabeculectomy and compound trabeculectomy groups increased slightly than that of preoperative, but it did no change significantly in Ahmed glaucoma valve implantation group. Sixty-five cases （98%） had effective filtering bleb in trabeculectomy group, 9 cases （82%） in compound trabeculectomy group and 3 cases in Ahmed glaucoma valve implantation group formed effectively bleb. CONCLUSION： For those patients with ineffective drug treatment, we can choose a different surgical approach, according to onset time, angle recession range and IOP, to effectively reduce lOP, improve visual acuity, and avoid further dama.cle to visual function.

关 键 词：外伤性房角后退 青光眼 小梁切除术 复合式小 

分 类 号：R779.6[医药卫生—眼科]