双侧Sturge－Weber综合征并发青光眼1例

双侧Ｓｔｕｒｇｅ－Ｗｅｂｅｒ综合征并发青光眼１例北京医科大学第一医院眼科殷悦，陈家彝，张立新双侧Ｓｔｕｒｇｅ－Ｗｅｂｅｒ氏综合征合并双侧青光眼极为罕见，作者治疗１例，报导如下。Ｓｔｕｒｇｅ－Ｗｅｂｅｒ氏综合征（ＳＷＳ）又名脑－眼－颜面血管瘤。ＳＷＳ合...     

青光眼术后前房消失伴脉络膜脱离的治疗

青光眼术后前房消失伴脉络膜脱离的治疗李宏科新疆乌苏解放军１５医院眼科（８３３０００１９８９年２月—１９９６年１２月共治各类青光眼手术病例５４７例（６０２眼），其中１９例１９眼手术后１—３天前房消失伴脉络膜脱离，用药物治疗无效，均经手术治愈，报告如下。...     

Sturge-Weber 综合征伴先天性心脏病一例

Ｓｔｕｒｇｅ－Ｗｅｂｅｒ综合征伴先天性心脏病一例林红王华孙为荣孟瑞华患者女，２８岁，因左眼胀、视力下降１年，近半个月症状加重，伴眼痛、头痛，于１９９５年１１月９日来我院就诊，门诊以“Ｓｔｕｒｇｅ－Ｗｅｂｅｒ综合征”收入院。患者出生时面部、躯干及四肢...     

青光眼复合式小梁切除术后浅前房原因及治疗

目的分析青光眼复合式小梁切除术后浅前房发生的原因和治疗效果。方法回顾性分析我院青光眼复合式小梁切除术后浅前房37例（38眼）的原因及治疗效果。结果青光眼复合式小梁切除术683眼中术后发生浅前房38眼（5．56％）。分析其原因主要为滤过过强18眼,结膜瓣渗漏3眼,脉络膜脱离11眼,睫状环阻塞性青光眼5眼,其他原因1眼。治疗采用的药物：睫状肌麻痹剂、高渗剂、皮质类固醇等和／或手术,包括：结膜瓣修补术,玻璃体抽液联合前房注气术等,32眼经过药物治疗前房形成,6眼药物治疗无效通过手术治疗后前房形成。结论38眼复合式小梁切除术后浅前房84．22％的术后浅前房可以通过药物形成前房,只有15．78％需要手术治疗。     

复合式小梁切除术后浅前房的原因分析

目的分析青光眼复合式小梁切除术后浅前房的原因。方法对68例130眼青光眼复合式小梁切除术后浅前房的发生程度进行分析，治疗。结果130眼发生浅前房19眼，占14．62％。结膜渗漏、引流过畅、脉络膜脱离及睫状环阻塞性青光眼是小梁切除术后浅前房的主要原因。结论术后浅前房是一种常见的并发症。手术结束时前房重建和术后及时治疗浅前房是重要的。     

青光眼小梁切除术后浅前房的原因及对策

目的 探讨青光眼小梁切除术后浅前房形成的原因及对策。方法 青光眼小梁切除术后用裂隙灯显微镜观察３个月，确定了浅前房发生的眼数及程度，采用加压包扎，扩瞳抗炎，甘露醇静滴。脉络膜脱出严重和恶性青光眼保守治疗无效时尽快行前房成形术，脉络膜上腔放液术，前玻璃体切除和晶体摘除术。结果 在小梁切除术１８４只眼中发生浅前房４８只眼，占２６．３７％，经治疗均恢复前房。结论 青光眼小梁切除术后浇前房的原因是复杂的，     

青光眼小梁切除术后浅前房的原因和治疗效果分析

目的 分析青光眼术后浅前房发生的原因和治疗效果.方法 回顾性分析我院青光眼小梁切除术后浅前房146例157眼的原因及治疗效果.结果 2001年7月～2005年6月我院进行的青光眼小梁切除术643眼巾,发生术后浅前房157眼,发生率为24.42%.157眼术后浅前房的原因主要为滤过过强65眼(41.40%),结膜瓣渗漏53眼(33.76%),脉络膜脱离20眼(12.74%),睫状环阻塞性青光眼14眼(8.92%),其它原因5眼(3.18%).采用约物:睫状肌麻痹剂、高渗剂,皮质类同醇等和/或手术:结膜瓣或巩膜瓣修补术、玻璃体抽液 前房注气术等治疗,157眼浅前房中140眼(89.17%)经过药物治疗前房形成,17眼(10.83%)药物治疗无效通过手术治疗后形成前房.结论 157眼青光眼小梁切除术后浅前房发生的原因主要为房水引流过畅、结膜瓣渗漏、脉络膜脱离及睫状环阻塞性青光眼.89.17%的浅前房可以通过药物治疗形成前房,只有10.86%的浅前房需要手术治疗.     

青光眼小梁切除术后脉络膜脱离的原因及防治

目的 探讨青光眼小梁切除术后脉络膜脱离的原因及防治方法 .方法 对242例(269眼)青光眼小梁切除术后发生的28例(32眼)脉络膜脱离进行回顾性分析.结果 28例(32眼)脉络膜脱离发生时间为术后1～5d,平均(3.21±1.22)d,术后脉络膜脱离的发生与术前眼压控制不佳、术中切口偏后及巩膜瓣偏薄有关.通过散瞳、抗炎、加压包扎、应用皮质类固醇及高渗剂等治疗而复位,1例Ⅲ度浅前房行脉络膜上腔放液前房形成而复位,均经UBM检查证实脉络膜下积液吸收.结论 青光眼小梁切除术后脉络膜脱离与术前眼压高、术中手术操作不当有关.一般经保守治疗可得到治愈,而早期通过UBM检查发现并采取相应措施可避免严重并发症的发生.     

Sturge-Weber综合征一例

Ｓｔｕｒｇｅ－Ｗｅｂｅｒ综合征又名血管、脑、三叉神经综合征，它有颜面血管瘤、青光眼、癫痫三大临床特征，笔者在临床遇到１例，现报告如下。１病例简介患儿，女性，７岁，以左眼视物不见１年为主诉于１９９７年７月１０日来我院就诊，门诊以Ｓｔｕｒｇｅ－Ｗｅｂｅｒ...     

显微小梁切除术后脉络膜脱离38例临床分析

目的 探讨青光眼显微小梁切除术后脉络膜脱离的常见原因及处理方法.方法 回顾性总结2004年1月至2007年12月期间连续收治的154例(189只眼)青光眼患者行显微小梁切除术后发生脉络膜脱离的原因及处理方法.结果 154例(189只青光眼)小梁切除术后38只眼发生脉络膜脱离.发生率为20%.其常见原因是术前眼压过高、切口偏后、巩膜瓣太薄及术终前房未形成.大部分患者经保守治疗数日或1周左右,前房即可恢复,脉络膜脱离亦可消退或很快消失,仅有6只眼需手术治疗.结论 术前眼压偏高、切口偏后、巩膜瓣偏薄、术中应用丝裂霉素及术毕前房不能形成是脉络膜脱离的主要原因.脉络膜脱离大多数可通过保守治疗治愈     

Sturge-Weber综合征继发青光眼的手术治疗

目的 总结Sturge-weber(sws)继发青光眼的手术治疗效果.方法 选自1999年11月至2005年12月连续6例10只眼SWS病例,对其进行手术治疗.观察手术近期及远期的眼压控制结果及并发症发生情况.结果 术前眼压25.81～50.62mmHg,平均34.3mmHg.术后近期眼压14.57～30.82mmHg,平均22.22mmHg,远期1例失访外眼压全部控制正常.眼底视盘没有进行性改变.没有术中术后.并发症发生.结论 对SWS病例严格掌握手术适应证,术前充分控制眼压,术中精细操作,仍可获得较高的手术成功率.     

Analysis of surgical and medical management of glaucoma in Sturge-Weber syndrome

Management of glaucoma associated with Sturge-Weber syndrome (SWS) is difficult. The authors reviewed 36 eyes of 30 SWS patients with either early or late-onset glaucoma with a mean follow-up of 122 months (range, 24-253 months). Intervals between required surgical or medical interventions were analyzed. Intervention was attributed to elevated intraocular pressure (IOP) in 55% of cases and disc change in 45%. Median stable postoperative interval with goniotomy was 12 months; with trabeculotomy, 21 months; with trabeculectomy, 34 months; with argon laser trabeculoplasty, 25 months; and with medications, 57 months. Survival analysis shows statistically significant differences between goniotomy and medications. Intraoperative choroidal expansions developed in 24% of cases receiving a trabeculectomy, and none developed with either goniotomy or trabeculotomy.     

Non-penetrating deep sclerectomy for glaucoma associated with Sturge-Weber syndrome

PURPOSE: To report the results of non-penetrating deep sclerectomy (NPDS) in the treatment of glaucoma associated with Sturge-Weber syndrome (SWS). METHODS: We carried out a retrospective case series analysis of patients who underwent NPDS for glaucoma associated with SWS between 1998 and 2003. The control of glaucoma after NPDS, the results of surgery on intraocular pressure, the need for additional medical treatment and surgical complications were studied. RESULTS: Twelve eyes of nine patients, aged 11 days to 24 years, underwent filtering surgery: nine NPDS procedures were performed and three surgical procedures had to be converted to trabeculectomy because NPDS was not technically achievable. The mean follow-up after surgery was 26.3 months (range 6-48 months). Two trabeculectomies were complicated by choroidal effusion, which resolved in both cases. Good control of glaucoma was obtained during follow-up. CONCLUSIONS: Non-penetrating deep sclerectomy is transiently efficient in the treatment of SWS-associated glaucoma. Further studies of NPDS for the treatment of glaucoma associated with SWS are warranted.     

睫状体冷凝联合全结膜瓣遮盖术治疗并发角膜溃疡的绝对期青光眼

目的探讨睫状体冷凝联合全结膜瓣遮盖术治疗并发角膜溃疡的绝对期青光眼的临床疗效。方法并发角膜溃疡的绝对期青光眼18例（18眼）施行睫状体冷凝联合全结膜瓣遮盖术。术后观察眼部症状，角膜、结膜愈合情况及眼压等。结果随访平均（9．4±1．9）个月。所有患眼球结膜瓣与角膜牢固贴附。术后2d眼压开始下降，而后呈逐渐下降的趋势，至术后1个月时基本稳定。结论在严格病例选择的基础上，睫状体冷凝联合全结膜瓣遮盖术治疗并发角膜溃疡的绝对期青光眼的初步效果良好。     

Latanoprost in glaucoma associated with Sturge-Weber syndrome: benefits and side-effects.

PURPOSE: This study was conducted to evaluate the ocular hypotensive efficacy, safety, and side effects of latanoprost 0.005% administered as adjunctive therapy in patients with Sturge-Weber syndrome (SWS) and glaucoma. METHODS: Commercially available latanoprost 0.005% was added as a single drop once daily to other antiglaucoma medications. Intraocular pressure (IOP) was measured at 1, 3, and 6 months of treatment. A successful response was defined as a reduction of at least 20% in IOP at the final follow-up evaluation without additional medical or surgical therapy and no adverse events related to latanoprost. RESULTS: 18 eyes of 18 patients with SWS and glaucoma were enrolled from 9 clinical centers. Mean baseline IOP was 28.4 +/- 7.1 mmHg (range, 17-42 mmHg). Using Kaplan-Meier analysis, a successful response to latanoprost was observed in 3 of 18 (16.7%) patients at the 6-month interval. Seven (38.9%) patients required surgery; three (16.7%) patients required additional medical therapy, seven (38.9%) patients had no change in therapy. One (5.6%) patient discontinued latanoprost treatment because of intolerable conjunctival hyperemia. Two successfully treated patients had significantly greater episcleral vessel engorgement after initiation of latanoprost therapy. CONCLUSION: Patients with SWS and glaucoma respond poorly to adjunctive latanoprost therapy and often require additional medical or surgical intervention. Increased episcleral vascular engorgement might result in greater operative risks should filtration surgery become necessary in these patients.     

Sturge–Weber syndrome: decrease in intraocular pressure after transpupillary thermotherapy for diffuse choroidal haemangioma

Purpose: To report intraocular pressure (IOP) reduction after selective and partial destruction of diffuse choroidal haemangioma (DCH) by transpupillary thermotherapy (TTT) using an 810 nm infrared diode laser in two patients with Sturge–Weber syndrome (SWS) having late‐onset juvenile glaucoma (LOJG). Methods: An interventional small case series. Laser spots (diameter, 1 mm) were applied to the tumour surface located outside the posterior pole. Energy level (600–1700 mW) and exposure time (1–4 seconds) were increased stepwise until the tumour exhibited a greyish discoloration. The treatment was split into 2–4 sessions. Results: Before TTT, both patients had uncontrolled LOJG with an IOP of 23 mmHg ( Case 1 ) and 45 mmHg ( Case 2 ) in spite of topical medications. In both cases, TTT led to normalization of IOP to 15 mmHg and 24 mmHg, respectively, and stopped the progression of LOJG during a follow‐up period of 6 years ( Case 1 ) and 1 year ( Case 2 ). Visual loss or other complications were not observed. Conclusions: Our study highlights the close link that exists between LOJG and DCH in SWS. A single treatment modality such as TTT may both reduce IOP in LOJG and help to prevent exudative retinal detachment in DCH. We believe that TTT is a good therapeutic option for SWS patients who have both DCH and LOJG.     

青光眼术后白内障超声乳化术的临床观察

目的探讨抗青光眼术后白内障超声乳化术的手术技巧,并评价手术效果。方法对22例24眼抗青光眼术后白内障行颞侧透明角膜切口超声乳化人工晶体植入术,术后随访3~6个月,观察视力、眼压和并发症的情况。结果21眼术后视力有不同程度提高,术后眼压在正常范围内,手术并发症主要是后囊破裂、晶体悬韧带部分离断和虹膜损伤。结论青光眼术后白内障经透明角膜切口行超声乳化效果良好,应强调角膜内皮细胞的保护和防止术后高眼压。     

Two-staged Baerveldt glaucoma implant for childhood glaucoma associated with Sturge-Weber syndrome

PURPOSE: To report the outcome and complications of 10 eyes of 9 children with Sturge-Weber syndrome (SWS) who underwent two-stage insertion of a Baerveldt glaucoma implant (BGI) for glaucoma. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: The authors reviewed the medical records of children under the age of 14 years with SWS who underwent two-stage BGI for glaucoma at two tertiary care referral centers. MAIN OUTCOME MEASURES: Intraoperative and postoperative complications, intraocular pressure (IOP), number of glaucoma medications, visual acuity, and further surgical intervention. RESULTS: Ten eyes of nine patients were included in the study. Ages of the nine patients at time of first stage BGI ranged between 6 weeks and 13 years. With average follow-up of 35 months (range, 10-50), all eyes had adequate IOP control (< or = 21 mmHg) without the need for additional glaucoma surgery. Intraocular pressure was reduced from a mean (+/- standard deviation) of 24.8 +/- 6.2 mmHg preoperatively to 16.9 +/- 2.3 mmHg at last follow-up visit (P = 0.001). The number of medications used for control of glaucoma was reduced from a mean (+/- standard deviation) of 1.8 +/- 1.0 preoperatively to 1.1 +/- 1.4 at last follow-up visit (P = 0.2). One eye had serous choroidal effusions with overlying serous retinal detachment that resolved spontaneously after 7 days with no permanent visual loss, and one eye had low choroidal effusion that lasted 4 days. There were no intraoperative or postoperative suprachoroidal hemorrhages. At last follow-up, visual acuity had improved by one or more lines in all patients in whom vision was measurable. CONCLUSIONS: Two-stage BGI surgery appears to be a safe and effective treatment for refractory glaucoma in children with SWS.     

Intravitreal sodium hyaluronate and secondary glaucoma after complicated phacoemulsification

We report 4 cases that presented with intractable glaucoma after complicated phacoemulsification during which sodium hyaluronate 1.0% (Healon) was used to tamponade a central posterior capsule rupture. The postoperative intraocular pressure (IOP) was uncontrolled on maximal medical therapy. In 2 patients, the IOP took 8 to 10 weeks to resolve and simultaneous ultrasound B-scans showed the presence of clear globules in the anterior and midvitreous that became smaller with conservative therapy. An early pars plana vitrectomy in 2 cases immediately controlled the IOP. The presence of globules presumed to be sodium hyaluronate in the vitreous cavity of the patients while the IOP was elevated suggests a causal relationship with the refractory secondary glaucoma.     

Primary combined trabeculotomy-trabeculectomy for early-onset glaucoma in Sturge-Weber syndrome.

OBJECTIVE: To evaluate the safety and efficacy of primary combined trabeculotomy-trabeculectomy in the management of early-onset glaucoma associated with Sturge-Weber syndrome (SWS). DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Ten eyes of nine patients were included in this study. All patients with SWS who underwent primary combined trabeculotomy-trabeculectomy from January 1993 through December 1996 were included. One patient had bilateral surgery. INTERVENTION: Primary combined trabeculotomy-trabeculectomy. MAIN OUTCOME MEASURES: Pre- and postoperative intraocular pressures (IOPs), corneal clarity and diameters, visual acuities, success rate, bleb characteristics, time of surgical failure (if any), and complications. RESULTS: The mean preoperative IOP was 28.2 mmHg +/- 7.35 mmHg with medication (mean, 1.2 +/- 0.6; range, 0-2). The mean postoperative IOP was 11.8 mmHg +/- 1.8 mmHg, with a mean percent reduction of 55.8 +/- 12.6 in IOP (P < 0.0001). All eyes maintained a postoperative IOP < 16 mmHg without medication over a mean follow-up of 27.6 +/- 16.4 months (range, 12-64 months). Normal corneal clarity was achieved in all eight eyes that had corneal edema. There were no significant intraoperative complications. Postoperatively, one patient developed a shallow anterior chamber with choroidal detachment, which was successfully managed conservatively. CONCLUSION: Primary combined trabeculotomy-trabeculectomy is safe, effective, and sufficiently predictable to be considered the first choice of surgical treatment in early-onset glaucoma associated with SWS.