恶性青光眼20例临床分析

目的:探讨恶性青光眼的发病机制与发病因素、临床症状与体征、治疗方法。方法:对20例恶性青光眼的临床资料进行回顾性分析。结果:通过药物控制眼压恢复的13眼,玻璃体切除术结合药物治疗使病情得到有效控制的6眼,1眼药物治疗失败,因拒绝手术导致失明。结论:充分了解恶性青光眼的发病机制与发病因素、临床症状与体征,制定合理的治疗方案,手术与药物治疗相结合,能有效治疗各种恶性青光眼。     

恶性青光眼的联合手术治疗

目的 :探讨恶性青光眼的可能的发病机理、手术治疗方案及其疗效。方法 :对 12例 (16眼 )恶性青光眼的发病情况、联合手术的方案以及手术治疗的时机进行分析。结果 :联合手术对药物治疗无效的恶性青光眼患者全部有效。结论 :恶性青光眼发病的机理可能与睫状突、晶状体和玻璃体前界膜之间的异常关系有关。对保守治疗失败的患者应及时采用手术治疗 ,而联合手术治疗方案可取得良好效果。     

恶性青光眼的诱因

有关恶性青光眼的概念和范畴,目前仍有争论。但这类青光眼无一例外均具有明显的诱因。本文从手术及非手术两方面,复习了文献所报道的恶性青光眼的诱因。说明了恶性青光眼的两个重要特征是:治疗中均对睫状肌麻痹剂显效;发病机制离不开睫状阻滞和晶体-虹膜隔前移的作用。这对进一步阐明恶性青光眼的定义和范畴,有一定意义。     

恶性青光眼

1896年vonGraefe首次提出恶性青光眼的概念，它最初是指发生在某些肉眼手术后的一种罕见的严重并发症。后来，一些对传统缩瞳剂和游过性手术治疗无效的闭角型青光眼也包括进来。近十余年来，随着眼科技术的发展，对恶性青光眼的病因和发病机制有了进一步的认识，它不仅发生于闭角型青光眼和开角型青光眼手术后，而且可以发生于白内障人工晶体等手术后，另外虹膜睫状体炎，外伤等均可诱发；不仅见于老年人、青壮年、甚至见于儿童，在客观上造成概念上的混淆。本文查阅了近年来可搜集到的有关文献，对恶性青光眼的定义、分类、诱因、发病机制及治疗作一综述。     

超声生物显微镜(UBM)在恶性青光眼发病机制诊断中的作用

目的 探讨超声生物显微镜在恶性青光眼发病机制中的诊断价值。方法 对临床上拟诊为恶性青光眼的患者行压平眼压、UBM、B超检查。结果 1．本文所有患者均有脉络膜上腔积液的存在，2．经脉络膜上腔放液后前房重建，联合晶状体摘除均能取得良好效果。结论 UBM在恶性青光眼发病机制及治疗中有一定指导性和实用性，是一种新的客观的非侵害性的检测方法。     

恶性青光眼

作者治疗66例恶性青光眼,对本病的特点,发病机制和治疗进行了讨论,并提出药物治疗常规和新的手术方法。恶性青光眼是抗青光眼手术的严重合并症之一,占闭角型青光眼的2—4％。其特点是术后     

原发性闭角型青光眼发病机制的研究进展

原发性闭角型青光眼是主要的不可逆致肓眼病.随着影像技术在眼科应用的进展,人们对前房角关闭机制的了解越来越深入.目前认为它的发病机制主要包括瞳孔阻滞机制、高褶虹膜机制、晶状体诱发性机制、恶性青光眼、脉络膜膨胀机制及混合机制.因各种发病机制的影响因素和治疗原则有所差异,要求针对前房角关闭患者的病因治疗不能千篇一律.动态生理性改变将是前房角关闭的重要研究方向之一.     

原发性闭角型青光眼发病机制的研究进展

原发性闭角型青光眼是主要的不可逆致肓眼病.随着影像技术在眼科应用的进展,人们对前房角关闭机制的了解越来越深入.目前认为它的发病机制主要包括瞳孔阻滞机制、高褶虹膜机制、晶状体诱发性机制、恶性青光眼、脉络膜膨胀机制及混合机制.因各种发病机制的影响因素和治疗原则有所差异,要求针对前房角关闭患者的病因治疗不能千篇一律.动态生理性改变将是前房角关闭的重要研究方向之一.     

原发性闭角型青光眼发病机制的研究进展

原发性闭角型青光眼是主要的不可逆致肓眼病.随着影像技术在眼科应用的进展,人们对前房角关闭机制的了解越来越深入.目前认为它的发病机制主要包括瞳孔阻滞机制、高褶虹膜机制、晶状体诱发性机制、恶性青光眼、脉络膜膨胀机制及混合机制.因各种发病机制的影响因素和治疗原则有所差异,要求针对前房角关闭患者的病因治疗不能千篇一律.动态生理性改变将是前房角关闭的重要研究方向之一.     

前段玻璃体及晶体切割治疗恶性青光眼

恶性青光眼治疗困难,随着对其发病机制的认识,玻璃体在其发病中的作用日益受到重视,所以玻璃体手术用于治疗恶性青光眼已获得满意效果〔1～3〕。本文报告2例前段玻璃体切割联合晶体切割治疗恶性青光眼均取得满意疗效,介绍如下。例1　男　62岁　右眼胀痛伴同侧头痛、恶心呕...     

恶性青光眼十年临床回顾分析

对1979年12月至1989年12月10年间我院临床确诊的91例恶性青光眼病例进行了回顾性研究。重点对它的危险因素及发病机制中新的临床发现进行了分析和讨论。对恶性青光眼处理方面10年的进展进行了总结,提出了诊断及治疗原则,基于资料分析结果,对恶性青光眼的命名及分类提出了新的建议。     

青光眼滤过术后合并睫状体脉络膜脱离的恶性青光眼

目的探讨青光眼滤过术后合并睫状体脉络膜脱离的恶性青光眼的发病机制、临床特点及预防。方法对4例（4只眼）青光眼滤过术后合并睫状体脉络膜脱离的恶性青光眼患者的临床资料进行回顾性分析。结果 4例（4只眼）在术后早期即出现Ⅱ°、Ⅲ°浅前房,通过眼底检查、手术及超声生物显微镜（UBM）检查发现睫状体脉络膜脱离、睫状环阻滞,经睫状体脉络膜上腔放液,并根据病情联合玻璃体水囊抽吸、前段玻璃体切除以及晶状体手术等,所有患眼眼压均恢复正常,前房加深,脉络膜脱离消失。结论睫状体脉络膜脱离是发生恶性青光眼的诱发因素,预防睫状体脉络膜脱离是预防恶性青光眼发生的关键;对术后早期即出现的Ⅱ°、Ⅲ°浅前房,及时进行UBM检查有助于明确诊断,可减少治疗的盲目性。     

Malignant glaucoma and severe myopia. Report of a case

Malignant glaucoma is a rare and dramatic complication that occurs more frequently after glaucoma filtration surgery for angle closure glaucoma and rarely for open angle glaucoma. We report a case of a highly myopic monocular 38-year-old woman, with a primary open angle glaucoma who developed malignant glaucoma in the first postoperative days of a trabeculectomy. Treatment consisted of extracapsular cataract extraction and vitrectomy, with the removal of the anterior hyaloid and preventive circular buckling. Late postoperative events have been marked by the occurrence of anterior synechiae and residual hypertension. We discuss the pathogenesis of malignant glaucoma, its management and the results of the different therapeutic procedures.     

The contribution of vitreoretinal surgery to the management of refractory glaucomas.

Vitreoretinal techniques, although not new, are only gradually being recognized in the management of refractive glaucoma. Besides rare but established indications for vitrectomy, as in malignant glaucoma, vitreoretinal surgery may become even more valuable by offering an alternative outflow route to the choroid that remains open and functional. Vitreoretinal surgery in neovascular glaucoma is primarily meant to be antivasoproliferative surgery. Vitrectomy-lensectomy accesses the eye for panretinal laser coagulation, the only effective treatment of ocular neovascularization so far. Vitrectomy is a way of interfering with the pathogenesis of ocular new vessel formation, which otherwise inevitably leads to phthisis.     

Malignant glaucoma

The term "malignant glaucoma" referred originally to a rare and highly feared form of glaucoma occurring in certain postoperative patients. Over time the concept of the disease was expanded to include a group of angle closure glaucomas unresponsive to traditional miotic or filtering therapy. The haphazard lumping of many disease entities under such an umbrella term has caused confusion, which we attempt to resolve through a mechanistic approach to elucidating the pathogenesis of malignant glaucoma based on the anatomical location of obstruction to normal aqueous flow; surgical treatments are suggested based on the pathogenesis. Attention is drawn to the role of the vitreous and anterior hyaloid in combination with a block to normal aqueous circulation, redirection of its flow, high intraocular pressure and vitreous swelling in precipitating malignant glaucoma and creating a vicious circle to maintain it. Surgical management is directed to correcting the obstruction to normal aqueous flow and removing aqueous accumulated in the posterior chamber, vitreous or suprachoroidal space.     

小梁切除联合玻璃体抽液术治疗术中恶性青光眼倾向疗效观察

观察小梁切除术联合玻璃体抽液术治疗术中有恶性青光眼倾向患者的疗效。 方法：青光眼患者19例 20眼术中从角膜穿刺口注水恢复前房检查巩膜瓣渗漏情况时,表现为前房浅眼压高的患者,予以玻璃体穿刺抽液、前房注黏弹剂的方法治疗。 结果：患者19例术后无1例浅前房,出院眼压为5~22.5（平均10.4）mmHg,视力较术前提高者5例6眼,下降者9例9眼,3例3眼有玻璃体出血。 结论：小梁切除术中出现恶性青光眼倾向患者常为伴有睫状体前位晶状体前移的闭角型青光眼,术中联合玻璃体抽液术,可有效预防术后恶性青光眼的发生。     

MALIGNANT GLAUCOMA RELATED TO PRIMARY ANGLE CLOSURE GLAUCOMA

In 800 cases of primary angle closure glaucoma, the overall incidence of malignant glaucoma was 0.6%. From 465 iridectomies for treatment, there was only one (0.2%), and from 427 filtering operations the incidence was only 0.7% (This should not be construed as showing the relative difference in risk between peripheral iridectomy and filtering operations, because most of the iridectomies had open angles at the time of operation, whereas most of the eyes that required filtering operations had more severe acute glaucoma with angles that remained closed.) The risk of malignant glaucoma is sufficiently low that filtering operations for closed angle glaucoma should not be avoided on this account. In the absence of subsequent glaucoma, no malignant glaucoma occurred with 372 prophylactic peripheral iridectomies. The multifactorial nature of malignant glaucoma is discussed. Laxity of the zonule is important, and this can occur as the result of severe and prolonged angle closure glaucoma. Future treatment should be more optimistic.     

晶状体超声乳化摘除联合前段玻璃体切割治疗恶性青光眼

目的：评价超声乳化摘除晶状体联合前段玻璃体切割治疗恶性青光眼的疗效，并对具体操作手法作一介绍。方法：对23例青光眼术后恶性青光眼患者行联合手术，回顾分析其临床资料。结果：全部病例术后前房形成，其中20例眼压控制良好，1例需加用抗青光眼药物治疗，2例再行阀门管植入术以控制眼压。22例视功能得到不同程度的改善。结论：超声乳化摘除晶状体联合前段玻璃体切割是治疗恶性青光眼的有效手段。     

YAG激光虹膜根部造孔术与恶性青光眼的预防

目的:探讨YAG激光与恶性青光眼的预防。方法:通过对恶性青光眼早期保守治疗无效的患者行YAG激光虹膜根部造孔术,从而使前后房沟通,促进前房形成。结果:对恶性青光眼早期保守治疗无效的患者行YAG激光虹膜根部造孔术,能阻止其发展。结论:YAG激光虹膜根部造孔能有效预防恶性青光眼的发生。