Optical coherence tomography in malignant glaucoma following filtration surgery

AIM: To assess the value of slit lamp adapted optical coherence tomography (OCT) for the management of malignant glaucoma following filtration surgery. METHODS: Two patients (three eyes) developed malignant glaucoma following filtration surgery for primary open angle glaucoma (POAG). With slit lamp adapted OCT it was possible to image non-invasively the anterior chamber angle structures during the malignant glaucoma episode, and after pars plana vitrectomy (PPV) with anterior chamber reformation. RESULTS: OCT revealed in both patients a markedly decreased anterior chamber angle with extreme shallowing of the anterior chamber depth during the acute malignant glaucoma phase. This critical closure of the anterior chamber angle resolved after PPV and deepening of the anterior chamber with viscoelastic. After PPV the quantitative values of the anterior chamber angle (ACA) and the anterior chamber opening distance (AOD) increased from 0 to an ACA of 35 degrees (SD 14 degrees ) and an AOD of 426 (SD 162) micro m. CONCLUSIONS: Non-contact slit lamp adapted OCT was helpful to evaluate the anterior chamber structures in malignant glaucoma, and thus could improve management of this serious clinical disorder.     

恶性青光眼的临床特征和危险因素分析

目的　探讨原发性闭角型青光眼（ｐｒｉｍａｒｙａｎｇｌｅｃｌｏｓｕｒｅｇｌａｕｃｏｍａ,ＰＡＣＧ）患者行手术治疗后发生恶性青光眼的临床特征以及相关的危险因素。方法　回顾性分析我院收治的２３８６例（２８９７眼）ＰＡＣＧ行手术治疗患者的临床资料,按术后是否发生恶性青光眼分为恶性青光眼组与非恶性青光眼组,探讨恶性青光眼组患者的临床特征,并采用Ｌｏｇｉｓｔｉｃ回归方法对ＰＡＣＧ患者术后发生恶性青光眼危险因素进行分析。结果　ＰＡＣＧ患者手术后恶性青光眼的发生率为２．９３％。恶性青光眼组患者的女性比例、行小梁切除术比例、术前眼压、晶状体厚度、房角完全闭合比例均显著高于非恶性青光眼组（均为Ｐ＜０．０５）,前房深度、眼轴长度均显著低于非恶性青光眼组（均为Ｐ＜０．０５）。两组间的年龄、病程、血压、相对晶状体位置等临床参数比较,差异均无统计学意义（均为Ｐ＞０．０５）。女性、年龄４５～６０岁、小梁切除术、术前眼压＞３０ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ）、前房深度＜１．８ｍｍ、晶状体厚度＞４．５ｍｍ、眼轴长度＜２２ｍｍ、房角完全闭合是ＰＡＣＧ患者术后发生恶性青光眼的危险因素,其中,短眼轴、术前持续高眼压、房角完全闭合３个因素是ＰＡＣＧ患者术后发生恶性青光眼的独立危险因素。结论　性别、年龄、眼压以及患者自身的眼球解剖结构是ＰＡＣＧ术后发生恶性青光眼的易感因素,需引起临床研究者的重视。     

Ex-PRESS引流器植入治疗原发性开角型青光眼的疗效

目的：观察Ex-PRESS青光眼引流器植入治疗原发性开角型青光眼的临床疗效。

方法：原发性开角型青光眼患者41例54眼分为研究组和对照组。研究组19例25眼,行Ex-PRESS青光眼引流器植入; 对照组22例29眼,行小梁切除术。比较两组患者平均手术时间、术后视力、浅前房、眼压、滤过泡及其他并发症的情况。

结果：研究组手术时间34.60±4.43min,术后1d浅前房1眼、前房出血1眼; 术后1wk高眼压2眼; 术后3mo视力下降1眼、功能性滤过泡24眼、眼压11.5±5.8mmHg。对照组手术时间44.37±3.00min,术后1d浅前房13眼、前房出血渗出12眼; 术后1wk高眼压8眼; 术后3mo视力下降6眼、功能性滤过泡25眼、眼压13.6±6.7mmHg。研究组术后并发症较少,眼压控制更低,术后视力影响、功能性滤过泡与对照组相当。

结论：Ex-PRESS青光眼引流器植入治疗原发性开角型青光眼手术时间缩短,术后浅前房、前房出血渗出并发症少,安全性高,疗效好。     

青光眼术后继发恶性青光眼19例手术疗效观察

目的:评估前部玻璃体切除晶状体摘除联合小梁切除手术治疗恶性青光眼的临床效果。方法:我们回顾了19例(19眼)恶性青光眼患者接受前部玻璃体切除晶状体摘除联合小梁切除手术治疗的病例。恶性青光眼发生前青光眼包括急性闭角型青光眼4眼,慢性闭角型青光眼11眼,开角型青光眼2眼,先天性青光眼2眼。曾行手术包括虹膜周边切除术3眼,小梁切除术16眼。手术前后均进行最佳矫正视力、眼压和裂隙灯显微镜检查。结果:有15眼术后最佳矫正视力较术前均有不同程度提高。患者术前眼压为41.33±13.85mmHg;术后眼压降低为14.23±4.88mmHg。术后患者前房形成,术后早期炎症反应较重,术后4d减轻。术后常见的并发症包括角膜内皮水肿、皱褶和少量玻璃体脱入前房。结论:前部玻璃体切除晶状体摘除联合小梁切除手术是治疗恶性青光眼的有效方法。     

Sclerothalamectomy (STE): stable postoperative intraocular pressure regulation in primary open-angle and pseudoexfoliative glaucoma

BACKGROUND: Since the 70th years we operated the hemorrhagic glaucoma by a ciliary body exposure after Benedikt. In a few patients we noted a stable intraocular pressure regulation for years, often in these cases where there is no filtering bleb. This signifies, that the ciliary body is heavily involved in the resorption of the anterior chamber fluid. During the following next years we further developed this operating technique and we use it today successfully in the operative treatment of primary open angle- and pseudoexfoliative glaucoma. PATIENTS AND METHODS: Since march 1996 we performed a sclerothalamectomy in 46 eyes. In approximate the half of cases the operation was done combined with a cataract surgery. 27 eyes had a primary open angle and 19 eyes a pseudoexfoliative glaucoma with a mean preoperative intra-ocular pressure of 29.79 +/- 7.96 mm Hg respectively of 33.58 +/- 9.32 mm Hg. RESULTS: The mean follow-up was in the case of primary open angle glaucoma 18.3 +/- 8.9 (median 20) and in the case of pseudoexfoliative glaucoma 15.8 +/- 11 (median 16) months. The mean postoperative intra-ocular pressure, which range in the group of primary open angle glaucoma 13.9 +/- 1.6 mm Hg and in the group of pseudoexfoliative glaucoma 12.9 +/- 2.5 mm Hg, was significant lower with significant less postoperative medication compared with the preoperative values during the complete follow-up (p < 0.01). There was no evidence in a significant difference between the both groups regarding the postoperative complication rate and intra-ocular pressure. We observed altogether in 7 eyes a flat filtering bleb, 5/27 in the primary open angle glaucoma and 2/19 in the pseudoexfoliative glaucoma group. In all of other cases we didn't state a filtering bleb. CONCLUSION: The sclerothalamectomy leeds to a long-term stable intra-ocular pressure with a contemporary low complication rate in the case of primary open angle- and pseudoexfoliative glaucoma.     

Express青光眼微型引流钉治疗开角型青光眼的临床观察

目的观察Express青光眼微型引流钉治疗开角型青光眼的临床效果。方法回顾2015年1月至2015年10月我院开展Express青光眼微型引流钉治疗开角型青光眼22例(25只眼),随访观察术后1周、1个月、3个月、6个月视力、眼压、并发症、滤过泡形态。结果视力:术后随访半年,患者均无复视现象,视力无明显变化或稍有提高。眼压:术后眼压控制良好,与术前比较明显降低(P<0.05)。并发症:1只眼术后第1天出现浅前房,1只眼1周出现结膜伤口渗漏。滤过泡:1只眼第1个月出现滤过泡瘢痕化,其余患者均获得宽大弥散的功能性滤过泡。结论 Express青光眼微型引流钉治疗开角型青光眼是安全有效的手术方式,术中及术后风险低、并发症少。     

白内障超声乳化人工晶状体植入联合房角分离术治疗闭角型青光眼临床观察

目的 观察白内障超声乳化人工晶体植入联合房角分离术治疗合并有白内障的原发性闭角型青光眼的效果.方法 回顾2006年6月至2009年6月经治疗的原发性闭角型青光眼合并白内障35例(38只眼),行透明角膜切口晶状体超声乳化吸出、后房型人工晶状体植入术联合房角分离术.观察手术前后视力、眼压、前房深度、前房角及视野的变化,并分析术后并发症.随访6个月至3年.结果 术后随访期间所有术眼眼压较术前显著降低,中央前房深度明显增加,30只眼(占79%)房角完全开放,36只眼(94%)最佳矫正视力比术前提高.结论 白内障超声乳化人工晶状体植入联合房角分离术能有效降低眼压、加深前房、开放房角和提高视力,是有效安全的手术方法.

Abstract：

Objective To observe the clinical effects ofphacoemulsification and intraocular lens implantation combined with goniosychialysis for treatment of angle-closure glaucoma.Methods From June 2006 to June 2009,35 cases (38 eyes) of primary angle-closure glaucoma with cataract were performed phacoemulsification and intraocular lens implantation combined with goniosychialysis.The changes of vision,intraocular tension,anterior chamber depth,anterior chamber angle and visual field before and after operation were observed,while the postoperative complications were analyzed.The period of follow-up was six months to three years.Results The intraocular tension of 38 eyes remarkably decreased and the anterior chamber depth obviously increased,compared with that before surgery.The anterior chamber angles of 30 eyes (79%)were completely open and the optimal corrected vision of 36 eyes (94%) improved in different degrees.Conclusions Phacoemulsification and intraocular lens implantation combined with goniosychialysis is a safe and effective surgery for treatment of angle-closure glaucoma,which can effectively decrease intraocular tension,deepen anterior chamber,open anterior chamber angle and improve vision.     

小梁切除加巩膜瓣可拆除缝线术临床应用研究

目的 探讨巩膜瓣外置可拆除缝线在青光眼小梁切除术中的临床应用效果.方法 对已确诊的开角及闭角型青光眼126例,随机分为两组.实验组61例(120只眼),即小梁切除及虹膜周边切除.巩膜瓣两角缝合后,再行巩膜瓣两侧外置可拆除缝线,水密缝合.对照组为常规小梁切除术65例(113只眼),术后随访6-12个月.结果 术后1周两组眼压与术前相比差异有统计学意义,而两组问比较差异无统计学意义(t=1.85,P=0.08);术后6个月实验组平均眼压(14.34±3.95)mmHg,对照组(19.57±7.76)mmHg,差异有统计学意义(P相似文献   

Malignant glaucoma following combined Ahmed valve implant and phacoemulsification surgery for chronic angle-closure glaucoma

CASE REPORT: Simultaneous Ahmed valve implant, combined with phacoemulsification cataract surgery, is a useful therapeutic option for patients with chronic angle-closure glaucoma, when conventional filtering surgery fails. This combined approach permits both control of intraocular pressure and early recovery of visual function. We report the results in five patients successfully treated with this combined procedure, two of whom developed early postoperative malignant glaucoma. DISCUSSION: Predisposing anatomic features in patients with chronic angle-closure glaucoma, associated with sudden anterior chamber decompression and increased postoperative inflammation, may facilitate the development of malignant glaucoma following combined glaucoma implant and phacoemulsification surgery.     

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.     

Ultrasound biomicroscopy before and after goniosynechialysis

PURPOSE: To report the ultrasound biomicroscopic appearance of the anterior chamber angle before and after successful goniosynechialysis. METHODS: Interventional case report. Ultrasound biomicroscopy using a 50-MHz transducer was performed in the supine position preoperatively and postoperatively in a 76-year-old woman with angle-closure glaucoma. RESULTS: Ultrasound biomicroscopy of the anterior chamber angle demonstrated restoration of an open anterior chamber angle after goniosynechialysis. CONCLUSION: High-resolution imaging of the anterior segment to evaluate preoperative and postoperative anatomy may be useful in eyes undergoing goniosynechialysis.     

原发性闭角型青光眼术后恶性青光眼发生的危险因素分析

目的：探讨原发性闭角型青光眼术后恶性青光眼发生的危险因素,为恶性青光眼的防治提供理论依据。

方法：回顾性分析2012-06/2016-06于我院眼科治疗的原发性闭角型青光眼患者767例965眼的临床资料,调查术后是否出现恶性青光眼,将术后1a出现恶性青光眼的患眼设为观察组,随机选取未出现恶性青光眼患者50眼设为对照组。调查两组患者性别、年龄、术前高眼压情况、房角结构、眼轴长度、晶状体厚度、前房深度、是否合并糖尿病、高血压等,单因素分析其危险因素,通过多因素Logistic回归分析探讨其独立危险因素。

结果：选取的965眼原发性闭角型青光眼患者中术后1a出现恶性青光眼30眼,恶性青光眼发生率为3.1%; 单因素分析结果显示：年龄、术前持续高眼压、眼轴长度、前房深度、晶状体厚度、房角完全关闭是原发性闭角型青光眼术后出现恶性青光眼的危险因素,组间比较差异具有统计学意义(P<0.05); 多因素Logistic回归分析结果显示年龄(OR=2.521,95%CI为1.434～8.876)、术前持续高眼压(OR=2.483,95%CI为2.123～11.543)、眼轴长度(OR=2.654,95%CI为1.547～12.678)、房角完全关闭(OR=3.212,95%CI为1.543～8.675)是原发性闭角型青光眼术后恶性青光眼的独立危险因素。

结论：我院原发性闭角型青光眼术后恶性青光眼发生率为3.1%,年龄、术前持续高眼压、眼轴长度、房角完全关闭均可增加恶性青光眼的发生风险,对于有该类危险因素的患者术中需特别注意。     

Anterior chamber depth in open angle glaucoma.

Anterior chamber depth was measured in patients with primary open angle glaucoma, low tension glaucoma, pigmentary dispersion syndrome, and glaucoma suspects. Multiple linear regression analysis demonstrated that anterior chamber depth is a function of sex, age, and refractive error. Values for anterior chamber depth corrected for age and refractive error were greater in patients with pigmentary dispersion syndrome than in patients with other forms of open angle glaucoma or in glaucoma suspects.     

我国青光眼手术治疗中存在的问题与思考

目前我国青光眼手术治疗中尚存在一些问题,例如为防范青光眼术后发生浅前房,将非穿透性小梁手术、闭角型青光眼晶状体摘除术的适应证扩大化;为防止青光眼术后滤过道纤维瘢痕化,滥用抗代谢药物、过度依赖巩膜瓣下填充物的作用等.针对这些问题,有必要寻找根本原因,纠正片面认识,进一步提高青光眼手术治疗的效果.(中华眼科杂志,2009,45:5-7)     

玻璃体切割术联合透明质酸钠植入术治疗开角型青光眼

目的:调查玻璃体切割术联合透明质酸钠植入术治疗开角型青光眼的临床效果,为合理选择手术方法提供参考。方法:开角型青光眼600例600眼根据入院顺序平分为两组,治疗组与对照组各300例,治疗组行玻璃体切割术联合透明质酸钠植入术,对照组采用玻璃体切割联合小梁切除术。结果:治疗后两组裸眼视力明显提高,治疗组视力改变更好(P＜0.05)。两组眼压经过治疗后有明显下降,治疗组在术后各个时间点的眼压都好于对照组(P＜0.05)。两组术后前房丁达尔征、前房积血和低眼压性黄斑病变发生率对比,均无明显差异(P＞0.05)。结论:玻璃体切割术联合透明质酸钠植入术治疗开角型青光眼能降眼压,视力恢复好,术后并发症少,值得推广应用。     

超声乳化术治疗急慢性闭角型青光眼的优越性

目的 探讨晶状体超声乳化吸出术治疗急慢性闭角型青光眼的效果和优越性.方法 回顾性分析超声乳化联合小梁切除术治疗原发性急慢性闭角型青光眼42例（48眼）的手术过程,观察手术效果,对术前与术后最佳矫正视力、瞳孔、眼压、前房角、前房深度、视野、眩光情况进行比较.结果 术后随访3个月以上,2眼（4.17％）视力低于术前,4眼（8.33％）视力无提高,其余42眼（87.50％）最佳矫正视力均较术前提高一行以上.42眼（87.50％）术后眼压为（15±6）mmHg（1 mm-Hg =0.133 kPa）.术后前房平均加深1.6 mm,术前关闭的前房角也有不同程度的开放,术后视觉舒适度均较术前改善,无一例发生严重并发症或后遗症.结论 晶状体超声乳化术在治疗原发性急慢性闭角型青光眼方面降压效果显著、增视、安全、并发症少.     

非穿透性与改良小梁手术治疗开角型青光眼的远期疗效

目的:观察非穿透性与改良小梁手术治疗开角型青光眼的远期疗效。方法:开角型青光眼患者15例(30眼),同一患者1眼行非穿透性小梁手术,另眼行改良小梁切除术,术后观察眼压、滤过泡、视野、房角和视力情况。结果:通过对非穿透性小梁手术与改良小梁切除术治疗开角型青光眼术后眼压、滤过泡、视野、房角和视力情况的长期观察、比较,二者疗效无显著性差异,非穿透性小梁手术组并发症较少。结论:非穿透性小梁手术是治疗开角型青光眼的有效方法。     

非穿透性小梁切除术和小梁切除术疗效比较

目的评估非穿透性小梁切除术与小梁切除术治疗开角型青光眼的临床疗效。方法有目的的选择12例双眼视力、眼压、视野相近的开角型青光眼病例,采用自身对照,一只眼行小梁切除术,另一只眼行非穿透性小梁切除术。术后观察眼压、前房和房水情况,评估疗效。结果小梁切除术术后眼压平均值要较非穿透性小梁切除术为低,但是通过自身对照的检验,两者无明显差异。非穿透性小梁切除术的术后并发症要比小梁切除术少。结论非穿透性小梁切除术是治疗开角型青光眼的有效方法。     

Non perforating trabecular surgery with reticulated hyaluronic acid implant

Non perforating trabecular surgery (NPTS) with reticulated hyaluronic acid implant (Skgel) allows aqueous humor to leave anterior chamber through a thin trabeculo-Descemet's membrane into a sclerocorneal space filled with Skgel implant and then via the outflow physiological channels. Good intraocular pressure results are obtained with less or without external filtration decreasing the incidence of per- and postoperative complications found after trabeculectomy. This surgery is actually only indicated for primary open angle glaucoma, the trabeculectomy still remaining the gold standard procedure for the other glaucoma cases.     

Trabeculectomy, a fistulizing operation with refixation of the scleral flap (author's transl)]

The study is based on 122 trabeculectomies performed on eyes with open angle glaucoma (glaucoma simplex). Satisfactory control of intraocular pressure was achieved in 80 to 90 percent of the eyes. Refixation of the scleral flap into its bed with sutures is an essential feature of the operation. This provides a valve mechanism. As a rule the valve does not open postoperatively unless the intraocular pressure has again reconstituted itself to some extent. Clinical advantages are: 1. Generally the anterior chamber has normal depth at the first postoperative day. 2. Postoperative hypotony is rare. 3. Usually postoperative inflammation is of low degree and of short duration. 4. Short hospitalisation. At present trabeculectomy is the authors operation of choice in eyes with glaucoma simplex.