青光眼滤过术后浅前房的临床探讨

目的 讨论青光眼滤过术后浅前房形成的常见原因及处理方法。方法 回顾性总结北京同仁医院青光眼组1998年10月～1999年10月期间连续收治的352例青光眼住院患者行青光眼滤过性手术后发生浅前房的原因、类型及处理方法。结果 共行青光眼滤过性手术495只眼，其中117只眼发生浅前房，发生率为23．64％。小梁切除术为19．2％(15／78)，小梁切除术 MMC为32％(93／291)，青光眼联合白内障的三联手术为7．1％(9／26)。浅前房发生在术后1～7天，其中滤过过畅36只眼(30．77％)、睫状体脉络膜脱离34只眼(29．06％)、结膜瓣渗漏27只眼(23．08％)、恶性青光眼15只眼(12．8％)、恶性青光眼合并睫状体脉络膜脱离3只眼(2．56％)、脉络膜上腔出血2只眼(1．71％)。需要手术治疗的35只眼，其余82只眼仅通过保守治疗均能恢复前房。结论 青光眼滤过术后浅前房发生率较高，其常见原因是房水滤过过畅、结膜瓣渗漏及睫状体脉络膜脱离。以小梁切除术 MMC的发生率最高，MMC不但能阻止滤过泡的纤维化，而且能使房水分泌减少。大多数浅前房可通过保守治疗治愈。

Shallow anterior chamber after filtering operation in patients with glaucoma

Objective To study the common causes and the managements of shallow anterior chamber after filtering operation of glaucoma.Methods 352 consecutive patients (496 eyes) with glaucoma in the branch of glaucoma,department of Ophthalmology,Tongren Hospital were retrospectively reviewed on the incidence,cause,type and management of postoperative shallow anterior chamber.Results The incidence of postoperative shallow anterior chamber in all the subjects and in the patients undergone filtering operations of trabeculectomy,trabeculectomy with mitomycin C,antiglaucoma combined with cataract surgery were 23 64% (117/495 eyes),19 2%(15/78),32%(93/291) and 7 1%(9/26),respectively.Shallow anterior chamber occurred in 1 to 7 days after operations and the causes were excessive aqueous over-filtration (30 77%,36 eyes),choroidal detachment (29 06%,34 eyes),filter bleb leaks (23 08%,27 eyes),malignant glaucoma (12 8%,15 eyes),choroidal detachment and malignant glaucoma (2 56%,3 eyes),and choroidal hemorrhage (1 71%,2 eyes).35 eyes needed surgical procedure for the reformation of anterior chamber.Anterior chamber reformed in other 82 eyes without any surgical procedure.Conclusions The incidence (23 64%) of shallow anterior chamber is high after filtering surgeries,especially in trabeculectomy with mitomycin C (32%) Most of the shallow anterior chamber can be reformed through conservative management.