急性闭角型青光眼前房角分离术的初步应用

目的探讨一种新的急性闭角型青光眼手术的技术效果。方法运用前房角分离技术或联合白内障摘出治疗28例(28眼)药物不能控制眼压的急性闭角型青光眼,并测量术后1周、10月的眼压。结果术后1周眼压均低于21mm-Hg;10月复查,患病1年之内的21例中眼压控制18例(85.71%),患病1年之上的7例中眼压控制5例(71.43%)。结论前房角分离术是将前粘连的周边虹膜从前房角上分离开,恢复小梁的功能,充分运用其生理性的房水循环通道,该术式损伤小,术后恢复快,再发生粘连可以重复手术,小梁功能丧失后可以重新做眼外引流手术。     

The effect of argon laser trabeculoplasty on the medical control of primary open-angle glaucoma

Argon laser trabeculoplasty was performed in 33 eyes with primary open-angle glaucoma whose intraocular pressures were poorly controlled on medical therapy. Five eyes (three patients) were failures and underwent trabeculectomy within three months. The remaining 28 eyes were followed up for 18 months and received a complete examination at periodic intervals. Beginning three months after trabeculoplasty, an attempt was made to decrease medications in a prospective manner in order to determine the least treatment required to maintain a pressure of less than 22 mmHg. No medication could be discontinued in 39% of eyes, whereas 18% were "cured" by trabeculoplasty and required no further medical therapy for control. Nine of 14 eyes that had been treated with carbonic anhydrase inhibitors were controlled without these drugs after trabeculoplasty. In 57% of eyes, the miotic could be discontinued. A total of 82% of cases still required some medication for pressure control after laser trabeculoplasty.     

超声乳化治疗白内障合并继发性闭角型青光眼

目的探讨单纯晶状体超声乳化吸出术联合后房型折叠人工晶状体植入术治疗合并有白内障的继发性闭角型青光眼的手术治疗效果。方法继发性闭角型青光眼45例（45眼），其中35例为继发性急性闭角型青光眼，10例为继发慢性闭角型青光眼，患者均有不同程度的晶状体浑浊。人院后均行透明角膜切口晶状体超声乳化吸出术联合后房型折叠人工晶状体植入术。术后随访3月～3年。对治疗效果进行临床分析。结果45例术中、术后没有出现严重的并发症。术后视力提两36例（80．00％），术后视力无明显提高者9例（20．00％）；术后眼压较手术前明显降低。结论单纯晶状体超声乳化吸出术联合人工晶状体植入术是治疗合并有白内障的继发性闭角型青光眼的一种有效的治疗方法。     

Timolol plus maximum tolerated antiglaucoma therapy: A one-year followup study

Thirty-three eyes of 22 patients with primary open-angle glaucoma or severe ocular hypertension had topical timolol maleate added to their maximally tolerated medical regimens. With minimal side effects, 25 eyes (76%) could be treated medically for one year, and only eight eyes (24%) required filtering surgery. Thirteen (39%) of the medically treated eyes achieved intraocular pressures of 21 mm Hg or less. After the addition of timolol, 17 of the 33 eyes (52%) completed the one-year protocol with final mean intraocular pressure decreases of 5 mm Hg or more on medical therapy.     

超声乳化术治疗闭角型青光眼的临床观察

目的观察超声乳化手术治疗闭角型青光眼的临床效果。方法回顾分析闭角型青光眼患者33例（38眼），抗青光眼术后患者8例（11眼），均在表麻下行经透明角膜隧道切口的白内障超声乳化联合折叠式人工晶状体植入术。结果眼压均得到控制，所有患者的眼压在21mmHg（1kPa=7．5mmHg）以下，31眼视力〉0．5，术后视力、眼压、中央前房深度、房角与术前相比，均有显著性差异。结论对于闭角型青光眼的治疗，白内障超声乳化联合折叠式人工晶状体手术是一种便捷、安全、有效的方法，具有降压和增视的双重效果。     

可调节缝线在小梁切除术中的应用

目的 :探讨小梁切除术中应用可调节缝线的方法和疗效。方法 :将 4 8例青光眼患者 (6 8只眼 )分为两组 ,A组 (36只眼 )在小梁切除术中应用可调节缝线 ,B组 (32只眼 )常规小梁切除术 ,观察两组术后眼压情况。结果 :术后半年眼压 <2 8kPa中 ,A组为 94 5 % ,B组为 75 0 % ,两组对比有显著差异。结论 :小梁切除术中应用可调节缝线能有效改善房水滤过 ,控制术后高眼压。     

青光眼滤过手术后高眼压的临床分析

目的：探讨青光眼患者行小梁切术后发生高眼压(>21mmHg)的常见原因及处理方法。
　　方法：回顾性研究我院2010-07/2014-09青光眼患者行小梁切除术后出现高眼压的病例24眼,分析其常见原因、处理方法。
　　结果：导致术后早期高眼压的因素有：发生滤过泡瘢痕11眼(46%)、滤过内口阻塞4眼(17%)、恶性青光眼3眼(12%)、虹膜切除不合理2眼(8%)、前房积血2眼(8%)、包裹性囊状滤过泡2眼(8%)。经对症治疗后,患者眼压均控制在21 mmHg以下。
　　结论：青光眼行小梁切除术后高眼压是由多因素造成的,术前、术中尽量避免,术后及早发现给予对症处理是手术成功的关键。     

Management strategies in malignant glaucoma secondary to antiglaucoma surgery

AIM: To assess the outcomes of various interventions for malignant glaucoma (MG). METHODS: A retrospective, comparative analysis of case series were performed on 38 eyes of 35 MG patients treated in Aier Eye Hospital of Wuhan between Jan. 2009 and Dec. 2012. Numerous treatments were administered including medical therapy, neodymium: yttrium- aluminium-garnet (Nd:YAG) laser posterior capsulotomy and hyaloidotomy as well as 3 surgical options. The characteristic, treatment option and outcome of MG in every individual patient were reviewed and analyzed among all patients who were followed up for an average of 27.1±9.1mo. RESULTS: Four eyes of 3 patients achieved complete resolution with medical therapy. Nd:YAG laser posterior capsulotomy and hyaloidotomy were performed on 2 eyes, both of which achieved resolution after initial intervention. Thirty-two eyes were given surgical treatments with anterior vitrectomy- reformation of anterior chamber in 13 eyes, phacoemulsification- intraocular lens implantation in 10 eyes and phacoemulsification- intraocular lens implantation- anterior vitrectomy in 9 eyes. Resolution of MG was seen in almost all patients. The mean intraocular pressure decreased from 41.87±9.44 mm Hg at presentation to 15.84±3.73 mm Hg at the last visit. The mean anterior chamber depth improved from 0.28±0.27 mm to 2.28±0.19 mm. Twenty eyes with preoperative visual acuity better than counting figure/ 50 cm had various visual improvements. Complications occurred in 3 eyes of 3 patients including bleeding at the entry site of vitrectomy into vitreous cavity, corneal endothelial decompensation and allergic to atropine respectively. CONCLUSION: MG occurs as a result of multiple mechanisms involved simultaneously or sequentially.Medical therapy is advocated as the initial treatment, laser therapy is beneficial in pseudophakic eyes, and different surgical regimen is recommended based on different pathogenesis of MG when non-response occurs to nonsurgical management. MG can be managed successfully by appropriate and timely interventions with good visual outcome.     

虹膜周边切除术47例临床观察

随访观察近五年虹膜周边切除术病人47例78眼。检查、记录其视力、眼压、房角图，对比二小时暗室低头试验前后高低眼压变动下房角变化情况。结果表明：宽基底虹膜周边切除术对急闭临床前期和间歇期，慢闭早期和混合性期，虹膜根赘合并单青均有较好的疗效。提示对虹膜周边切除术后眼压升高及二小时暗室低头试验结果阳性的“残余性”青光眼患者均需作进一步补充性治疗。同时也应避免因选择术式不当造成的“医源性”青光眼。     

Punctal occlusion and topical medications for glaucoma

We studied the effects of punctal occlusion on the intraocular pressures of patients treated with topical medications for glaucoma. Silicone punctal plugs were used to occlude the inferior punctum of one eye in each of 19 patients treated with identical antiglaucoma eyedrops in both eyes. The intraocular pressures before and after punctal occlusion were compared. The eyes with the punctal plugs showed a statistically significant (P less than .0001) decrease in pressure of 1.32 mm Hg after punctal occlusion when compared to that of the fellow control unplugged eyes. The intraocular pressures in the plugged eyes decreased an average of 1.82 mm Hg after punctal occlusion when compared to before punctal occlusion (P = .001). The intraocular pressure in the unplugged control eyes did not change significantly after punctal occlusion of the fellow treated eye.     

前房穿刺在青光眼治疗中的应用

目的:探讨前房穿刺术在青光眼治疗中的临床应用。方法:对210例239眼青光眼患者在术前或术中实施前房穿刺以降低眼压或观察手术效果等。其中22眼为急性闭角型青光眼急性发作高眼压经药物治疗不能有效控制的患者,行前房穿刺放出房水降低眼压;217眼为青光眼小梁切除术中常规行前房穿刺放出房水,注入平衡盐,以调节眼压,促进前房及滤枕形成,预防并发症发生。结果:急性高眼压患者经前房穿刺放液后症状迅速缓解,眼压下降,视力提高;青光眼做小梁切除术后除5例5眼发生Ⅰ度浅前房外,未见其它并发症。结论:前房穿刺应用于青光眼治疗中是降低眼压、预防术中及术后并发症的有效方法,特别适合于基层医院推广。     

晶体溶解性青光眼综合治疗的疗效观察

目的 探讨晶体溶解性青光眼综合治疗的效果.方法 对晶体溶解性青光眼27例(27只眼)进行综合治疗包括:术前降眼压及抗炎、手术将晶状体摘除并植入人工晶状体、术后抗炎治疗等.结果 24只眼Ⅰ期植入人工晶状体术后随访1～6月,眼压控制在9～19mmHg,视力(裸眼)恢复:0.07～0.5.其中＜0.1者1例;0.12～0.3者18例;＞0.3者5例.结论 晶体溶解性青光眼经规范的治疗并植入人工晶状体可取得较好的效果.     

Ahmed阀门在青光眼手术中的疗效分析

目的：评价Ahmed青光眼阀门在多种类型青光眼中的治疗效果。方法：对研究期间住院94例102眼青光眼患者予Ahmed青光眼阀门植入术,新生血管性青光眼患者术后1～2wk予全视网膜光凝。术后随访6mo以上,了解各期眼压、视力情况。结果：平均眼压从术前48.52±6.42mmHg降到术后6mo11.20±3.34mmHg。术后各时期平均眼压均低于21mmHg,与术前相比差异有显著性（P〈0.01）。102眼手术完全成功者96眼,基本成功者2眼,总有效率为96.1%。术后并发症包括短暂性前房出血、早期低眼压、浅前房等。结论：尽管Ahmed阀门植入存在一些并发症,但是对于青光眼是一种新的有效治疗方法。     

原发性闭角型青光眼高眼压状态手术时机探讨

目的:探讨原发性闭角型青光眼(primary angle-closure glaucoma,PACG)在高眼压状态下的手术时机及需注意问题。方法:回顾分析本院2009-01/2010-12PACG患者57例57眼在高眼压状态下(>40mmHg)进行手术治疗的效果。结果:手术均成功,无明显并发症。随访6mo,观察术后视力不同程度提高者有53眼(93%),视力无变化者有4眼(7%);眼压≤21mmHg者48眼(84%),联合局部用药眼压控制≤21mmHg有9眼(16%)。结论:对于PACG的急性发作,经局部及全身用药治疗后眼压仍不能下降,需紧急行抗青光眼手术,以抢救患者的视力,避免视功能的进一步损伤。     

Axenfeld-Rieger综合征继发青光眼15例临床分析

目的:探讨Axenfeld-Rieger综合征继发青光眼患者的临床表现及其治疗。方法:回顾性病例研究。收集我院2003-01/2016-01就诊的Axenfeld-Rieger综合征继发青光眼患者15例26眼的临床资料,并进行回顾性分析。结果:患者年龄跨度为3月龄~43岁,中位数年龄为11岁。15例患者中11例(73%)为双眼患病,4例(27%)为单眼患病。临床表现方面,有20眼(77%)可见虹膜萎缩或缺损;17眼(65%)有不同程度的虹膜前粘;14眼(54%)可见瞳孔变形或多瞳;14眼(54%)可见后胚胎环;11眼(42%)有角膜大小的异常。全部患眼房角检查均可见虹膜根部附着偏前,以及不同程度的房角粘连。根据资料,全部患者中仅2例具有家族性遗传史;5例除眼部异常外还伴有牙齿、上颌骨、心血管等全身其他系统发育异常。有20眼进行了抗青光眼手术治疗,手术方式包括小梁切开术、小梁切除术、青光眼减压阀植入术等。术后随访到了9例患者(11只术眼),平均随访59mo,随访时眼压均低于术前眼压(t=2.4185,P=0.0362),其中7只术眼眼压≤21mmHg,远期手术成功率64%。结论:Axenfeld-Rieger综合征继发青光眼的临床表现多种多样,患者可同时伴有全身其他系统发育异常,该病治疗棘手,抗青光眼手术能够有效降压,改善临床症状。     

青光眼引流器植入术在新生血管性青光眼治疗中的疗效观察

目的观察青光眼引流器植入术对新生血管性青光眼的治疗作用。方法回顾性总结33例新生血管性青光眼行青光眼引流器植入术的治疗结果。结果术后眼压控制较好,视力损伤小,并发症少。结论青光眼引流器植入术恢复快,对视力损伤小,对新生血管性青光眼是一种疗效较好的治疗方法。     

基层医院开展新生血管性青光眼手术疗效观察

目的:探讨基层医院对中晚期新生血管性青光眼(neovascular glaucoma,NVG)手术术式的选择和疗效观察。方法:选取20例21眼中晚期NVG患者,其中7例7眼行睫状体冷凝联合小梁切除术,11例12眼行全视视网膜联合睫状体冷凝术,2例2眼行睫状体冷凝联合涡静脉附近巩膜板层切除术。结果:术后所有患者疼痛症状明显好转,术后3mo眼压<24mmHg者19眼,2眼控制不稳定,最高时达28mmHg。视力5眼提高,14眼无变化,2眼眼球萎缩。所有患者虹膜新生血管全部消退。结论:在没有很好医疗条件的基层医院或患者经济条件不好的情况下,简易的手术方法同样可以解决患者的痛苦,挽救患者的眼球和有用视力,易于被患者接受。     

MANAGEMENT OF UNCONTROLLED GLAUCOMA WITH THE MOLTENO SYSTEM

In glaucomatous eyes refractory to medication, laser techniques and conventional drainage surgery, intraocular pressure is often high, and visual loss rapid. In this situation a reliable, robust artificial outflow system is required. Molteno has evolved a plastic tube and plate device combined with a fibrosis suppression medication regimen. Thirty-eight eyes of 32 patients with uncontrolled glaucoma were treated with the Molteno system. Six months after operation mean intraocular pressure had been reduced from 41.0 ± 13.6 to 16.2 ± 5.6 mmHg. Eighteen eyes had pressures of 20 mmHg or less on no hypotensive therapy, 17 on reduced treatment. Three eyes had a pressure of 21 to 35 mmHg on treatment at six months. The 13 aphakic eyes responded as well as 25 phakic eyes. Five eyes with rubeotic glaucoma demonstrated pressures of less than 20 mmHg without therapy, four eyes with traumatic glaucoma required continuing medication with three having pressures below 22 mmHg. Of the seven eyes with uveitic glaucoma, one was lost, two required maintenance therapy; five of six surviving eyes had pressures below 20 mmHg. Fifteen eyes with congenital or juvenile glaucoma achieved pressures below 20 mmHg, three of these with timolol drops, three with timolol and acetazolamide, and nine with no treatment. While seven of seven eyes with refractory primary open-angle glaucoma attained pressures below 20 mmHg. all seven needed continuing mild hypotensive therapy. Eleven eyes underwent a one-stage procedure, while 27 eyes required a two-stage operation. Twenty-eight eyes received fibrosis suppression medication after the second stage, and 24 maintained or improved their preoperative visual acuity. Results have been encouraging: in general the Molteno system is recommended as the second drainage operation in all glaucomatous eyes in which conventional therapy has failed, and as the primary surgical procedure (after laser techniques) in eyes with rubeotic and uveitic glaucoma. Ciliary body destructive procedures should be restricted to control of symptoms in blind eyes.     

Phacoemulsification in Patients with Secondary Glaucoma Caused by Uveitis

Purposes: To evaluate the effect of phacoemulsification in the patients with uveitis,secondary glaucoma and complicated cataract.Methods: Phacoemulsification and implantation of a foldable intraocular len wasperformed in 12 patients(13 eyes) with uveitis, secondary glaucoma and complicatedcataract. The complications, intraocular pressures (IOP), and visual acuity wereobserved postoperatively.Results: No severe complication was found in the patients postoperatively or within theoperation procedure. The visual acuity was improved after the operation ( P < 0. 05) .The intraocular pressures and/or the number of antiglaucoma medications reduced in 3months of the follow-up time.Conclusion: phacoemulsification is the best way to treat the patients with secondaryglaucoma and complicated cataract caused by uveitis.     

晶状体摘出联合前房角分离术治疗继发性闭角型青光眼

目的 观察晶状体摘出联合前房角分离术治疗继发性闭角型青光眼术后前房角形态的改变,并评价其疗效.方法 对36例(36眼)手术前后的视力、眼压、中央前房深度、前房角形态进行对照观察.结果 术后随访6个月～3年,36眼视力均较前有明显提高.36眼前房深度变深,术前前房深度(1.612±0.354)mm,术后前房深度(3.214±0.277)mm.术后眼压降低,术前眼压(28.69±4.12) mmHg,术后眼压(14.07±3.48) mmHg.术后1个月和6个月前房角镜检查,前房角全部开放31眼(86.11％),部分开放5眼(13.89％).随访至少6个月以上均未见前房角再次关闭或粘连范围扩大.结论 晶状体摘出联合前房角分离术可有效治疗继发性闭角型青光眼.