25G微创玻璃体切割联合晶状体摘出及抗青光眼手术治疗恶性青光眼的疗效  

Efficacy of 25 gauge minimally invasive vitrectomy combined with cataract extraction and trabeculectomy surgeries for malignant glaucoma

作　　者：孙超 谭澄烨 王清如 鲍迅 庄淼 姚勇 Sun Chao;Tan Chengye;Wang Qingru;Bao Xun;Zhuang Miao;Yao Yong(Department of Ophthalmology,Wuxi People's Hospital Affiliated to Nanjing Medical University,Wuxi 214023,China)

机构地区：[1]南京医科大学附属无锡人民医院眼科,无锡214023

出　　处：《中华实验眼科杂志》2019年第12期1000-1003,共4页Chinese Journal Of Experimental Ophthalmology

基　　金：南京医科大学科技发展基金面上项目(2016NJMU128)。

摘　　要：目的探讨25G微创玻璃体切割联合手术治疗恶性青光眼的疗效。方法采用回顾性队列研究。对2011年1月至2017年1月接受25G微创玻璃体切割联合手术治疗的恶性青光眼患者19例19眼的临床资料和术后的随访资料进行回顾性分析。根据患眼恶性青光眼诱因不同选择手术方法,小梁切除术后恶性青光眼者采用25G玻璃体切割+白内障超声乳化摘出+后囊膜切开术,非小梁切除术后恶性青光眼采用25G玻璃体切割+白内障超声乳化摘出+小梁切除+后囊膜切开术。采用国际标准视力表检测患者BCVA;采用A型超声仪测量眼轴长度;采用非接触眼压计测量治疗前后术眼眼压;采用超声生物显微镜(UBM)测量中央前房深度。结果所有患者手术顺利完成,术后有中重度前房炎症反应。纳入的患者中恶性青光眼平均发病年龄为(58.00±6.20)岁,平均眼轴长度为(20.81±0.56)mm。小梁切除术后发生恶性青光眼者11眼,青光眼白内障联合术后发生恶性青光眼者2眼,激光虹膜切开术后发生恶性青光眼者2眼,前房穿刺术后发生恶性青光眼者2眼,原因不明者2眼。术眼术后3个月视力均提高,与术前比较差异有统计学意义(Z=-3.826,P<0.001)。术眼术前眼压为(38.84±5.97)mmHg(1 mmHg=0.133 kPa),术后3个月眼压明显下降,为(12.16±2.27)mmHg,差异有统计学意义(t=17.68,P<0.05)。术眼术前中央前房深度为(0.95±0.28)mm,术后3个月中央前房深度加深,为(2.43±0.15)mm,差异有统计学意义(t=20.06,P<0.05)。UBM显示术眼术后睫状体位置正常,睫状体水肿消失。结论25G微创玻璃体切割联合手术治疗恶性青光眼疗效确切,能有效降低眼压,挽救患者视力,减少手术风险。Objective To evaluate the efficacy and outcome of 25 gouge(25G)minimally invasive vitrectomy combined with cataract extraction and trabeculectomy surgeries for malignant glaucoma.Methods Retrospective cohort study was performed.Clinical data of 19 malignant glaucoma patients(19 eyes)who received 25G minimally vitrectomy from January 2012 to January 2017 in Wuxi People's Hospital were reviewed retrospectively.The operative methods were selected according to the predisposing cause.25G vitrectomy combined with cataract extraction and posterior capsulotomy were performed on the malignant glaucoma eyes after trabeculectomy,and 25G vitrectomy combined with cataract extraction,trabeculectomy and posterior capsulotomy were performed on the malignant glaucoma eyes after non-trabeculectomy.Best corrected visual acuity(BCVA)was examined by international visual acuity chart.The ocular axis length and intraocular pressure(IOP)were measured with A-mode ultrasonic apparatus and non-contact tonometer,respectively.The anterior chamber depth was measured with ultrasound biomicroscope(UBM).The study followed the declaration of Helsinki and all patients signed informed consent before surgery.Results The operation was successfully completed in 19 patients.All patients suffered moderate to severe anterior chamber inflammation after operation.The average age of onset in the patients was(58.00±6.20)years,and the mean ocular axial length was(20.81±0.56)mm.Malignant glaucoma occurred in 11 eyes after trabeculectomy,2 eyes after combination of anti-glaucoma with cataract extraction,2 eyes after laser iridotomy,2 eyes after paracentesis of anterior chamber and 2 eyes with unknown causes.The visual acuity was significantly improved 3 months after operation in comparison with before operation(Z=-3.826,P<0.001).The mean IOP was(12.16±2.27)mmHg(1 mmHg=0.133 kPa)in postoperation,which was significantly lower than(38.84±5.97)mmHg in preoperation(t=17.68,P<0.05).The depth of anterior chamber was increased from preoperative(0.95±0.28)mm to pos

关 键 词：恶性青光眼/手术 生物测量 治疗结局 回顾性研究 微创玻璃体切割术 

分 类 号：R73[医药卫生—肿瘤]