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穿透性角膜移植术后继发青光眼的疗效分析
引用本文:郝静华,;骆非,;闫超,;潘志强. 穿透性角膜移植术后继发青光眼的疗效分析[J]. 眼科, 2014, 23(6): 392-397. DOI: 10.13281/j.cnki.issn.1004-4469.2014.06.009
作者姓名:郝静华,  骆非,  闫超,  潘志强
作者单位:100062.北京市普仁医院眼科(郝静华);100730 首都医科大学附属北京同仁医院 北京同仁眼科中心 眼科学与视觉科学北京市重点实验室(骆非、闫超、潘志强)
摘    要:目的 探讨穿透性角膜移植术后继发青光眼的治疗效果。设计 回顾性病例系列。研究对象 2010年1月至2013年1月北京同仁医院穿透性角膜移植术后继发青光眼的病例34例(34眼),原发病中眼外伤12眼,无晶状体眼或人工晶状体眼大疱性角膜病变6眼,粘连性角膜白斑4眼,角膜溃疡4眼。属于高危角膜移植术眼为23眼。方法 回顾患者的病例资料,包括矫正视力、眼压、裂隙灯下眼前节、超声生物显微镜(UBM)及眼前节相干光断层扫描(AS-OCT)。患者均先予降眼压药物治疗,无效者行抗青光眼手术治疗。疗效判断标准:予相应的治疗后眼压≤21 mmHg者或最终不需药物治疗为有效,>21 mmHg为无效。随访6~18个月(平均12.21±3.86个月)。主要指标 眼压。结果 34眼中,单纯用局部或全身降眼压药物者11眼(32.4%),药物及手术治疗者23眼(67.6%)。23例抗青光眼手术治疗者中1次手术11眼,2次8眼,3次2眼,4~5次2眼。术式选择二极管激光睫状体光凝术7眼,睫状体冷冻术2眼,睫状体光凝术、睫状体冷冻术5眼,睫状体光凝术、睫状体冷冻术、小梁切除术 5眼,白内障囊外摘除+小梁切除+前部玻璃体切除+瞳孔成形术1眼,睫状体光凝术、小梁切除1眼,EX-PRESS引流钉植入术1眼,小梁切除术、睫状体光凝术、睫状体冷冻术、睫状体分离+睫状体光凝术1眼。到最后一次随访时,单纯使用降眼压药物的11眼中,5眼(45.5%)最终不需药物治疗,5眼(45.5%)使用1~2种降眼压滴眼液有效,1眼(9%)无效;需手术及药物治疗的23眼中,6眼(26.1%)最终不需药物治疗,12眼(52.2%)使用1~2种降眼压滴眼液有效,2眼(8.7%)使用3种降眼压滴眼液有效,3眼(13.0%)无效。结论 约一半的穿透性角膜移植术后继发性青光眼患者在降眼压药物和手术治疗后仍需要1~2种降眼压药物治疗。

关 键 词:穿透性角膜移植术/并发症  继发青光眼  抗青光眼治疗  
收稿时间:2014-02-24

Effect analysis of treatment for post-penetrating keratoplasty glaucoma
HAO Jing-hua,LUO Fei,YAN Chao,PAN Zhi-qiang. Effect analysis of treatment for post-penetrating keratoplasty glaucoma[J]. Ophthalmology in China, 2014, 23(6): 392-397. DOI: 10.13281/j.cnki.issn.1004-4469.2014.06.009
Authors:HAO Jing-hua  LUO Fei  YAN Chao  PAN Zhi-qiang
Affiliation:1. Department of Ophthalmology, Beijing Puren Hospial, Beijing 100062, China; 2. Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
Abstract:Objective To investigate the treatment efficacy of the secondary glaucoma after penetrating keratoplasty (post-pene- trating keratoplasty glaucoma, PPKG). Design Retrospective case series. Participants 34 patients(34 eyes)with PPKG in Beijing Ton- gren Hospital from January 2010 to January 2013. The primary diseases were as the following: 12 eyes of ocular trauma, 6 eyes of bul- lous keratopathy in aphakic or pseudophakic eyes, 4 eyes of adhesive walleye, 4 eyes of corneal ulcers. There were 23 eyes of high-risk corneal keratoplasty. Methods A retrospective clinical data of patients, including corrected visual acuity, intraocular pressure(IOP), an- terior segment slit lamp, ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS-OCT) were reviewed. Patients were treated thoroughly with IOP lowering medications, if which was ineffective the glaucoma surgery underwent. Clinical effi- cacy criteria: after appropriate treatment, IOP ≤21 mmHg or needn't any medication in the end is effective, 〉 21 mmHg as invalid. The follow-up time was 6~18 months (mean 12.21±3.86 months). Main Outcome Measures IOP. Results In the 34 eyes, 11 eyes (32.4%) used local or systemic hypotensive drugs, 23 eyes (67.6%) used drug and operation treatment. It was found that in the 23 cases who accepted the glaucoma operation, 11 eyes were operated 1 time, 8 eyes 2 times, 2 eyes 3 times , 2 eyes 4 ~ 5 times. Surgical op- tions consisted of diode laser cyclophotocoagulation in 7 eyes, ciliary body cryotherapy in 2 eyes, cyclophotocoagulation, ciliary body cryotherapy in 5 eyes, cyclophotocoagulation, cyclocryotherapy, trabeculectomy in 5 eyes, cataract extraction and small beam excision of anterior vitrectomy + pupil forming operation in 1 eye, cyclophotocoagulation, trabeculectomy in 1 eyes, EX-PRESS drainage screw im- plantation in 1 eye, trabeculectomy, cyclophotocoagulation, cyclocryotherapy, cyclodialysis + cyclophotocoagulation 1 eye. At the end of the follow-u
Keywords:penetrating keratoplasty/complicatoins  secondary glaucoma  anti-glaucoma therapy
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