合并白内障外伤性晶状体半脱位继发青光眼个体化治疗  

Individualized treatment of traumatic lens subluxation with cataract in patients with secondary glaucoma

作　　者：王保君[1] 杨华[1] 张海涛[1] 李新民[1] 王小敏[1] 

机构地区：[1]河南新乡医学院第一附属医院眼科,453100

出　　处：《中国实用眼科杂志》2016年第6期615-618,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的对合并白内障的外伤性晶状体半脱位继发青光眼患者探讨合理有效的治疗方法。方法对2012年4月至2014年8月在新乡医学院第一附属医院眼科合并白内障的外伤性晶状体半脱位继发青光眼患者28例（28只眼）进行回顾性分析，根据患者晶状体脱位范围和房角情况选择不同的手术方法，17只眼单行白内障超声乳化联合前部玻璃体切除术；5只眼联合小梁切除术，3只眼行白内障超声乳化联合前部玻璃体切除术同时联合青光眼引流阀植入术；3只眼采取睫状体平坦部三通道玻璃体、晶状体切除术。对术后视力、眼压进行追踪观察6个月。结果所有患者术后6个月视力均有不同程度提高，最佳矫正视力0．05-0．6；25例眼压控制正常，3例（1例青光眼阀植入，2例小梁切除术）联合1种或2种降眼压药物可控制在21mmHg以下，所有患者术后6个月时平均眼压（18．71±2．14）mmHg，经统计学处理，（t=32．62，P〈0．01），和术前眼压比较差异具有统计学意义。人工晶状体位置除2例2袢缝合的稍有偏位外，其余位置均居中。结论对于外伤性晶状体半脱位继发青光眼的患者根据不同情况采取个体化治疗方案可有效地控制眼压，改善视功能。Objective To discuss the effective treatment for the cases of traumatic lens subluxation with secondary glaucoma and cataract. Methods The records of 28 cases （28 eyes） of traumatic lens subluxation with secondary glaucoma and cataract were reviewed. Various surgical procedures were performed according to the scope of lens subluxation and the condition of anterior chamber angle. Lens phacoemulsification （phaco） combined anterior vitrectomy were done for 17 eyes; Combined trabeculectomy were performed for 5 eyes; Lens phacoemulsification combined anterior vitrectomy and glaucoma drainage valve implantation were performed in＇3 eyes; Pars plana vitrectomy combined lensectomy were done in 3 eyes. The postoperative visual acuity and intraocular pressure were observed for 6 months. Results Postoperative visual acuity of all cases were improved, The best corrective visual acuity were 0.05-0.6 at six months postoperatively; 25 cases had intraocular pressure （IOP） controlled. IOP in 3 cases （1 case with glaucoma valve implantation, 2 cases with trabecutecto- my） with one or two medication of anti-glaucoma could be controlled below 21 mmHg. IOP in all cases was 18.71±2.24 mmHg at 6 months postoperatively. The difference of IOP between pre-operation and post-operation was statistically significant （t =32.62, P 〈0.01） except 2 eyes with 2 haptics stitching had IOL slightly offset, 26 eyes had the center position of IOL. Conclusions Individualized treatment can effectively control the intraocular pressure and improve the visual function in patients with secondary glaucoma after traumatic lens subluxation according to the different situation.

关 键 词：晶状体脱位 白内障 继发性青光眼 个体化治疗 

分 类 号：R779.66[医药卫生—眼科]