青光眼滤过术后恶性青光眼合并睫状体脉络膜脱离

目的：探讨青光眼滤过术后恶性青光眼合并睫体脉和膜脱离的特点及治疗方法。方法：对10例12只青光眼小梁切除术后恶性青光眼合并睫状体脉络膜脱离的临床资料作回顾性分析。结果：4只眼经1－3次脉络膜上腔放液联合抽玻璃体水囊联合前房注气术后，3只眼压恢复正常，1只眼前房不恢复，改行前部玻璃体切除联合超声乳化白内障吸除及人工晶状体植入术。其余8只眼均一次行前 部玻璃体切除联合超声乳化白内障吸除及人工晶状体植入术，眼压控制正常，前房形成.结论：青光眼滤过术后恶性青光眼合并睫状体脉络膜脱离为难治并发症。脉络膜上腔放液联合抽玻璃体水囊治疗有效，前玻璃体切除联合超声乳化白内障吸除及人工晶状体植入术可提高一次手术成功率。     

恶性青光眼的预防及处理

目的:探讨恶性青光眼的预防措施和治疗方法。方法:回顾性分析2001-03/2006-06我院经治的15例17眼恶性青光眼的临床资料,采用综合药物治疗和手术治疗,手术方法包括单纯经睫状体扁平部玻璃体腔穿刺抽液术或联合前房重建术;晶状体摘除、部分晶状体后囊膜、玻璃体前界膜、前部玻璃体切除术及再滤过术。结果:术后随访1~63(平均17.2±4.1)mo。术后眼压平均15.1±3.5mmHg(1mmHg=0.133kPa),全部前房深度恢复且稳定,视力保持,无严重并发症。结论:对药物治疗无效的恶性青光眼应及时采用手术疗法。单纯经睫状体扁平部玻璃体腔穿刺抽液术或联合前房重建术能有效缓解部分早期恶性青光眼,且能防止严重并发症的发生。晶状体超声乳化、人工晶状体植入、部分晶状体后囊膜及玻璃体前界膜和前部玻璃体切除、再滤过术的多种联合手术,能有效治疗各种恶性青光眼。     

白内障超声乳化人工晶状体植入联合前段玻璃体切除治疗恶性青光眼

目的：评价超声乳化人工晶状体植入术联合前段玻璃体切除三联术治疗恶性青光眼的效果。方法：12例(14眼)继发于小梁切除术后晶状体混浊的患者，在药物治疗基础上，行超声乳化白内障摘除术，后囊连续环形撕囊，直径约为4mm，再行前段玻璃体切割，最后囊袋内植入人工晶状体。结果：所有病例眼压得到控制，前房形成良好，视力得到不同程度的提高。结论：超声乳化人工晶状体植入术联合前段玻璃体切除三联术是治疗恶性青光眼的一种有效手段。     

抗青光眼术后浅前房的前房重建手术

目的 探讨青光眼滤过术后浅前房的手术方法和效果.方法 取17例抗青光眼术后浅前房患者经保守治疗无效,有7只眼发生脉络膜脱离,5只眼行脉络膜上腔放液+前房成形术,1只眼行白内障超声乳化及人工晶状体植入术及前房成形术,1只眼行脉络膜上腔放液+白内障超声乳化及人工晶状体植入术+前部玻璃体切割术+前房成形术.有9只眼发生恶性青光眼,1例行抽玻璃体水囊联合前房成形术,3例行前部玻璃体切除及后囊切开联合小梁切除及丝裂霉素联合白内障超声乳化及人工晶状体植入及房角分离术,1例行前部玻璃体切除术中发生脉络膜脱离及脉络膜上腔出血行前部玻璃体切除联合玻璃体腔放液,2只眼行前部玻璃体切除联合白内障超声乳化及人工晶状体植入及房角分离术,1例行前部玻璃体切除联合前房成形术,术后前房仍浅又行白内障超声乳化及人工晶状体植入及后囊膜切开及房角分离术,1例为视网膜脱离术后硅油存留眼行白内障超声乳化联合虹膜周边切除术及前房成形术.结果 术后前房恢复时间脉络膜脱离组行脉络膜上腔放液及前房成形术平均为5.6d,恶性青光眼组行白内障超声乳化及人工晶状体植入术联合前部玻璃体切除及后囊切开组前房恢复时间最短,平均为1.1d.结论 恶性青光眼组行白内障超声乳化及人工晶状体植入术联合前部玻璃体切除及后囊切开治疗有效快速.     

恶性青光眼手术治疗远期疗效探讨

目的探讨恶性青光眼手术治疗的远期效果。方法回顾性分析1997年1月至2005年2月在我院手术治疗的恶性青光眼患者19例(23只眼)的手术方式、术后视力、眼压情况。结果 19例(23只眼)中,12只眼单纯超声乳化白内障吸除联合后房型人工晶状体植入,其中6只眼于术后1月内病情复发,经分别或联合行激光后囊切开、玻璃体前界膜切开、前部玻璃体切除,甚至房水引流管植入后才得以缓解。11只眼行超声乳化白内障吸除联合前部玻璃体切除 后房型人工晶状体植入,未见复发。患者的视力较术前提高,眼压得到控制。结论超声乳化白内障吸除联合前部玻璃体切除 后房型人工晶状体植入为治疗恶性青光眼的有效方法。     

超声乳化、人工晶体植入、经平坦部玻璃体切除治疗恶性青光眼

目的：评价超声乳化、人工晶体植入、经平坦部前段玻璃切除治疗恶性青光眼的效果。方法：11例13眼继发于小梁切除术后的恶性青光眼接受了手术治疗。首先经平坦部行前段玻璃体中央切割减压（至15．0mmHg左右）,然后常规白内障超声乳化摘除和直径3．0mm的连续后囊撕开,再切割前段的玻璃体,最后向睫状沟位植入人工晶体。结果：术后第一天,所有病例前房均形成良好,无一例前房再消失。视力改善显著,眼压控制满意。     

恶性青光眼的多联手术治疗

目的 探讨多联手术治疗恶性青光眼的疗效。方法 15例有晶体眼的恶性青光眼行白内障超声乳化联合前房形成、前段玻璃体切除和/或抗青光眼手术;5例人工晶体眼的恶性青光眼行前段玻璃体切除手术联合Ahmed青光眼阀门植入术。术眼均同时切开晶状体后囊膜及玻璃体前界膜。结果 术后随访5至35个月,术后眼压较术前明显下降（P〈0.001）,前房深度明显加深（P〈0.001）,矫正视力前后差异无统计学意义。结论 恶性青光眼为多种机制混合存在的难治性、复杂性青光眼,多联手术是比较有效的治疗方法。     

恶性青光眼的临床特点与防治方法

目的探讨恶性青光眼的临床特点与防治方法。方法回顾分析12例（13只眼）恶性青光眼的临床资料及治疗方法。本组病例角膜直径9．5—11mm,平均10．8mm。眼轴长17．8～22．5mm,平均21．9mm,发生于慢性闭角型青光眼小梁切除术后11只眼,占84．6％。6只眼行药物治疗,其中2只眼联合YAG激光治疗;5只眼行晶状体摘除联合人工晶状体植入、后囊截开、前部玻璃体切除术;2只眼行晶状体摘除联合人工晶状体植入、小粱切除术,再次经睫状体平部行前部玻璃体切除、晶状体后囊膜部分切除术。结果出院时患者眼压在10-15mm Hg,中央及周边前房形成。随访观察10个月至5年,平均20个月,前房稳定,眼压15—21mm Hg,平均18．7mm Hg。结论恶性青光眼好发于小角膜、短眼轴的慢性闭角型青光眼小梁切除术后,药物治疗、无晶状体眼联合Y-AG激光治疗可以控制部分恶性青光眼,晶状体摘除联合人工晶状体植入、后囊截开、前部玻璃体切除手术可以治愈药物不能控制的恶性青光眼。     

玻璃体切除联合超声乳化术治疗脱位晶状体疗效分析

目的 探讨玻璃体切除联合超声乳化粉碎术治疗脱位晶状体的临床疗效.方法 对晶状体脱位46例(46只眼).其中晶状体不全脱位28只眼中单纯超声乳化12只眼,前玻璃体切除联合超声乳化5只眼,前玻璃体切除11只眼,均植入人工晶体;晶状体全脱位18只眼均采用标准三通道经睫状体扃平部玻璃体切除联合超声乳化粉碎术,人工晶体睫状沟固定术12只眼.结果 全部病例术后视力均较术前提高,未发生严重并发症.结论 对脱位的晶状体根据程度选择单纯超声乳化或玻璃体切除超声乳化粉碎、人工晶体睫状沟固定术,是一种安全、有效的治疗方法.     

恶性青光眼手术治疗远期疗效探讨

目的 探讨恶性青光眼手术治疗的远期效果。方法 回顾性分析1999年7月至2002年12月在我院手术治疗的恶性青光眼患者17例(17眼)手术方式、术后视力、眼压情况。结果 17例患者(17眼)中，12眼单纯行超声乳化白内障吸除联合后房型人工晶体植入，其中6眼于术后0．5月～10个月病情复发，经分别或联合行激光后囊切开、玻璃体前界膜切开、前部玻璃体切除。甚至房水引流管植入、睫状体光凝术后才得以缓解。5眼行超声乳化白内障吸除联合前部玻璃体切除、后房型人工晶体植入，未见病情复发。患者的视力较术前提高，眼压得到控制。结论 单纯超声乳化吸除白内障联合后房型人工晶体植入对早期或药物治疗能部分缓解的恶性青光眼有效；对弥漫性房角关闭、周边虹膜前粘连的顽固病例，超声乳化白内障吸除联合前部玻璃体切除、后房型人工晶体植入为较佳选择。     

Effectiveness of surgical management of malignant glaucoma in phakic eyes

AIM:To assess the effectiveness of core vitrectomyphacoemulsification-intraocular lens(IOL)implantationcapsulo-hyaloidotomy in treating phakic eye at least 1 mo after the onset of malignant glaucoma.METHODS:A retrospective analysis were performed on malignant glaucoma patients treated in Zhongshan Ophthalmic Center between 2016 and 2018.Demographic and clinical data were described.The preoperative and postoperative visual acuity(VA),intraocular pressure(IOP),number of IOP-lowering medications used,and anterior chamber depth(ACD)of the case series were compared by Wilcoxon signed-rank test.RESULTS:Thirteen phakic eyes with long time intervals between onset and surgery were identified in this case series.Core vitrectomy-phacoemulsification-IOL implantation-capsulohyaloidotomy reduced the IOP(P=0.046)and the number of IOP-lowering medications used(P=0.004),deepened the ACD(P=0.005).Complete success was achieved in 38.5%of the eyes,and anatomical success was achieved in 100%of the eyes without any recurrence.The only postoperative complication observed is corneal endothelial decompensation.It occurred in two cases.CONCLUSION:Core vitrectomy-phacoemulsification-IOL implantation-capsulo-hyaloidotomy is safe and effective for treatment of long onset phakic malignant glaucoma.     

Phacoemulsification combined with posterior capsulorhexis and anterior vitrectomy in the management of malignant glaucoma in phakic eyes

Purpose: To describe sequential phacoemulsification–intraocular lens (IOL) implantation–posterior capsulorhexis–anterior vitrectomy in the management of phakic malignant glaucoma. Methods: Twenty consecutive patients (25 eyes) with phakic malignant glaucoma were enrolled at the Zhongshan Ophthalmic Center, Sun Yat‐sen University. All patients underwent phacoemulsification, IOL implantation and posterior capsulorhexis together with anterior vitrectomy via a clear corneal paracentesis. Visual acuity, intraocular pressure (IOP), anterior chamber depth (ACD), surgical complications and medications required after the surgery were recorded. Results: After surgery, the mean LogMAR visual acuity and ACD increased significantly (visual acuity from ?1.56 ± 1.17 to ?0.54 ± 0.81, p < 0.001; ACD from 0.367 ± 0.397 mm to 2.390 ± 0.575 mm, p < 0.001), and mean IOP decreased significantly (from 39.6 ± 10.6 mm Hg to 14.5 ± 4.1 mmHg, p < 0.001). No serious perioperative complications occurred, and only five eyes required topical glaucoma medications after surgery. Conclusion: Combined phacoemulsification–IOL implantation–posterior capsulorhexis–anterior vitrectomy surgery is a safe and effective method for treating patients with phakic malignant glaucoma.     

Videoendoscope-guided fluorescein-assisted vitrectomy for phakic malignant glaucoma

Malignant glaucoma is a rare secondary glaucoma classically occurring after intraocular surgery in eyes with primary angle closure. Pars plana vitrectomy is reserved for the treatment of malignant glaucoma when medical and laser treatment fail. The primary aim of surgery is the removal of the anterior vitreous to reduce resistance to aqueous flow into the anterior chamber. In phakic eyes, conventional pars plana vitrectomy without lens extraction is frequently unsuccessful because of difficulty visualizing the normally transparent anterior vitreous, combined with the technical challenge of removing the anterior vitreous without damaging the crystalline lens. We describe a technique of intraocular, videoendoscope-guided, fluorescein-assisted pars plana vitrectomy that enables direct visualization and thorough removal of the anterior vitreous without the need for lens extraction in prepresbyopic patients without cataract.     

迟缓型恶性青光眼的特点及治疗方法的选择

目的:探讨迟缓型恶性青光眼的特点及治疗方法的选择。方法:观察12例(14眼)迟缓型恶性青光眼出现的时间、眼压、前房深度及处置方法的选择。结果:术后出现恶性青光眼的时间1～8(平均3.1)mo;前浅房程度:Ⅱ°:7眼,Ⅲ°:7眼;眼压:28～46(平均34.6)mmHg。3眼经药物治疗后恢复前房;其余分别选择手术治疗;2眼行玻璃体水囊抽吸+前房成形术;2眼行玻璃体水囊抽吸+前房成形+Phaco+后囊截开术;3眼行前部玻璃体部分切除+Phaco+后囊截开术;4眼行前部玻璃体部分切除+Phaco+后囊截开+IOL术;术后均恢复前房。术后眼压14～23(平均18.3)mmHg。结论:慢性炎症刺激引起的瞳孔后粘连是迟缓型恶性青光眼发生的主要原因。前部玻璃体部分切除+Phaco+后囊截开+IOL术是迟缓型恶性青光眼最有效的治疗方法。     

无灌注玻切联合晶状体超声乳化及小梁切除治疗有晶状体眼的恶性青光眼

目的：探讨利用23 G微创无灌注玻璃体切割联合白内障超声乳化并小梁切除术治疗有晶状体眼的恶性青光眼的疗效,分析前后节复合手术治疗恶性青光眼的诊疗思路。
　　方法：有晶状体眼恶性青光眼患者21例21眼采用23 G玻切头进行前节玻璃体切割及玻璃体前界膜切开,玻切操作迅速且无需灌注及縫合,超声乳化人工晶状体植入联合小梁切除需进行晶状体后囊膜环形撕囊。术后观察视力、眼压、前房变化及术后并发症。
　　结果：术后3mo眼压从术前57.18±6.18mmHg降至16.15±2.43mmHg,两者差异有显著统计学意义(P<0.001);术前房角深度为0.88±0.25mm,术后增至2.44±0.37mm,术后前房深度较术前显著加深(P<0.001);术后视力较术前明显提高,无严重并发症发生。
　　结论：23 G微创无灌注前段玻璃体切割联合白内障超声乳化并小梁切除的复合手术方法,可以有效治疗有晶状体眼的恶性青光眼发作,恢复部分功能性视力。根据恶性青光眼发病机制及临床体征,进行早诊断、早发现、早治疗,前后节三联手术能有效控制并且能长时间维持稳定的眼内压。     

LXII Edward Jackson lecture: open angle glaucoma after vitrectomy

PURPOSE: To present data and an hypothesis for the late development of open angle glaucoma (OAG) after vitrectomy. DESIGN: A retrospective observational case series. METHODS: The records of 453 eyes that had undergone vitrectomy were reviewed for postoperative OAG. Eyes with confounding factors were excluded. Sixty-eight eyes of 65 patients that underwent routine vitrectomy were followed for a mean of 56.9 months (range, seven to 192 months). For the main outcome measures, patients were classified into three groups: patients with suspected glaucoma, patients in whom glaucoma developed after the operation, and patients with pre-existing glaucoma. RESULTS: In glaucoma suspects, the mean intraocular pressure was significantly higher in the operated eye compared with the fellow eye (P = .0001). In eyes with new onset glaucoma, 23 of 34 eyes (67.6%) had it in the vitrectomized eye only. In phakic eyes, the time interval between vitrectomy and the development of glaucoma (mean, 45.95 months) was significantly longer than eyes that were nonphakic at the time of vitrectomy (mean, 18.39 months; P = .0115). When the interval between cataract surgery in phakic eyes to the development of glaucoma was compared with the interval from vitrectomy to glaucoma diagnosis in the nonphakic group, the difference was not statistically significant. In eyes with glaucoma before the operation, the mean number of antiglaucoma medications that were required to control the intraocular pressure was significantly higher in the vitrectomized eye, compared with the fellow eye (2.9 medications +/- 1.2 vs 2.0 medications +/- 1.4; P = .0215; n = 14). CONCLUSION: There is an increased risk of OAG after vitrectomy. The presence of the lens may be protective. In established OAG before the operation, the number of antiglaucoma medications may increase after surgery. Oxidative stress is hypothesized to have a role in the pathogenesis.     

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。     

Post-penetrating keratoplasty glaucoma: Risk factors, management and visual outcome

Purpose: To evaluate the incidence, associated risk factors, graft status and treatment modalities in patients with post-penetrating keratoplasty glaucoma. Methods: A retrospective analysis of 747 consecutive penetrating keratoplasties was undertaken at a tertiary eye care centre. The frequency of post-penetrating keratoplasty glaucoma was determined and correlated with the pre-operative corneal diagnosis, lens status and associated surgeries performed during penetrating keratoplasty. The response to antiglaucoma therapy (i. e. medical, surgical or cyclo-destructive procedures) and graft outcome was also evaluated. Results: The incidence of post-penetrating keratoplasty glaucoma was 10.6% (79/747). Pre-operative corneal diagnosis of adherent leucomas was significantly associated with the development of postoperative glaucoma. Post-penetrating keratoplasty glaucoma was significantly higher in aphakes (odds ratio (OR) 6.6; confidence interval (CI) 3.81–11.69) compared with phakic or pseudophakic eyes. Associated vitrectomy (OR 2.32; CI 1.16–4.73) and anterior segment reconstruction (OR 3.31; CI 1.43–7.72) were other high-risk factors. Most patients responded to medical therapy (41/79; 51.9%), whereas filtering surgery and cyclodestructive procedures were performed in 29.1 (23/79) and 19% (15/79) of eyes, respectively. Despite clear grafts in 39 eyes (49.4%), visual acuity of 6/18 or better was achieved in 15 eyes (18.9%). Conclusions: A high incidence of post-penetrating keratoplasty glaucoma occurs in eyes with adherent leucomas. Anterior vitrectomy and associated surgeries further accentuate the risk. Anti-glaucoma threrapy may not achieve optimum visual outcome, despite a clear graft.     

恶性青光眼12例手术治疗分析

目的:探讨两种手术方法对恶性青光眼的治疗效果。方法:对12例16眼小梁切除术后的恶性青光眼患者,晶状体核硬度≤2级,视力≥0.1者采取抽吸玻璃体水囊联合前房注气重建(A术)。晶状体核硬度≥3级,视力<0.1者采取抽吸玻璃体水囊、联合白内障囊外摘除+人工晶状体植入+晶状体后囊膜、玻璃体前界膜切开(B术)。结果:所有病例经4～5d药物治疗均无效,其中5例7眼采取A术,有2眼前房形成后又消失,再次行A术后获成功,余均一次性成功。7例9眼采取B术者均全部成功,随访5～13(平均9)mo,全部病例眼压得到控制,前房深度恢复正常,视力得到有效保护,无严重并发症。结论:恶性青光眼采取A,B两种术式可以有效的控制眼压,保护视功能。