微创联合手术治疗持续高眼压下原发性闭角型青光眼  

Minimally invasive operation in treatment of primary angleclosure glaucoma under persistent high intraocular pressure

作　　者：牛静宜[1] 金玲[1] 刘晓红[1] 张宏[1] 

机构地区：[1]深圳市宝安区人民医院,广东深圳518100

出　　处：《中国医药科学》2016年第13期218-220,224,共4页China Medicine And Pharmacy

基　　金：广东省深圳市宝安区科技计划社会公益项目(2015031)

摘　　要：目的探讨原发性闭角型青光眼持续高眼压下行玻璃体穿刺放液术及白内障超声乳化联合房角分离的安全性及有效性。方法回顾性分析2013年9月-2015年1月在我院行玻璃体穿刺放液术及白内障超声乳化联合房角分离治疗的原发性闭角型青光眼患者27例（31眼）,比较术前及术后视力、眼压、前房深度及术中、术后并发症等情况。结果术后1周有19眼（61.29%）视力得到提高,术后1个月时视力提高者为23眼（74.19%）,到术后6个月时视力提高者达到26眼（83.87%）。术后1周,28眼眼压〈21mmHg,3眼≥21-30mmHg,术后3个月,3眼眼压仍偏高者中2眼经药物治疗后眼压保持正常,1眼药物治疗效果不佳行小梁切除术,术后眼压控制良好。术后6个月,2眼在局部药物控制下眼压保持正常,29眼在无药物控制下保持正常。术前前房深度≥1/4CT者占38.7%（12/31）;术后1d,31眼前房均形成,无浅前房发生,前房深度≥1/4CT者占100%,与术前相比得到显著提到（χ^2=10.0833,P〈0.05）。无严重并发症发生。结论微创联合手术治疗持续高眼压下原发性闭角型青光眼,不仅可有效降低眼压,避免了视神经的不可逆性损害,还为外滤过手术保留了完整的结膜组织,是安全有效的。Objective To explore the clinical effects of vitreous cavity paracentesis and phacoemulsification combined with goniosynechialysis in treatment of primary angle-closure glaucoma（PACG） under persistent high intraocular pressure（IOP）. Methods 27 cases（31 eyes） of PACG with cataract under high IOP performed with phacoemulsification combined with goniosynechialysis and vitreous cavity paracentesis in our hospital from Sep. 2013 to Jan. 2015 were selected.The visual acuities,depth of anterior chamber,IOP and complications before and after the operation were observed. Results The postoperative visual acuity improved in 19 eyes（61.29%） at 1 week,23 eyes（61.29%） at 1 month and 26 eyes（83.87%） at 6 month respectively.The postoperative 1 week,IOP was 21 mmHg in 28 eyes and ≥ 21-30 mmHg in 3 eyes,at postoperative 3 month,in 3 eyes of intraocular pressure still on high,2 eyes needed additional medical treatment and 1 eye recovered after additional trabeculectomy and the intraocular pressure was well controlled after operation.At postoperative 3 month,2 eyes maintained normal IOP under local drug control,29 eyes maintained normal IOP without local drug control.In pre-operation, the chamber depth ≥ 1/4CT ratio was 38.7%（12/31）,the postoperative 1d,the chamber depth ≥ 1/4CT ratio was 100%,and they were significantly increased than those of pre-operation（χ^2=10.0833,P〈0.05）.There was no serious complication happened in all cases after the surgery. Conclusion Minimally invasive operation in treatment of primary angle-closure glaucoma under persistent high intraocular pressure can avoid irreversible damage to the optic nerve,and can preserve the integrity of the conjunctival tissue for filtration surgery.It is safe and effective.

关 键 词：原发性闭角型青光眼 持续高眼压 玻璃体穿刺放液术 白内障超声乳化 房角分离 

分 类 号：R779.6[医药卫生—眼科]