玻璃体抽吸术在药物难控制性急性闭角型青光眼治疗中的应用

目的:探讨玻璃体抽吸术在药物难控制性急性闭角型青光眼治疗中的作用。方法:回顾分析我院住院患者共60例60眼,男28例,女32例,入院诊断符合急性闭角型青光眼发作期临床特征,且药物治疗24h后眼压仍>21mmHg的急性闭角型青光眼患者,其中控制眼压为21～35mmHg者26眼(43%),眼压～50mmHg者18眼(30%),50mmHg以上者16眼(27%)。视力范围为光感～0.3。所有患者行局部麻醉下睫状体平坦部玻璃体抽吸术治疗,吸出玻璃体液0.4～1.0mL,术后继续观察眼压、视力、前房深度变化,眼压控制稳定后分别进行单纯抗青光眼术、青光眼白内障联合人工晶状体置换术,或白内障摘除人工晶状体植入术。出院后门诊观察,随访6～12mo。结果:患者60例60眼急性闭角性青光眼行玻璃体抽吸术后,第3d检测眼压≤21mmHg者14眼(23%),眼压为～35mmHg者29眼(48%),眼压～50mmHg者13眼(22%),眼压>50mmHg者4眼(7%);抽吸术后视力增加2行的为28眼(47%),视力增加1行的24眼(40%),视力不增加的8眼(13%);58眼前房深度增加(97%);抽吸术后并发前房出血16眼(27%)。眼压控制稳定后分别进行单纯抗青光眼术14眼,青光眼白内障联合人工晶状体置换术28眼,白内障摘除人工晶状体植入术18眼。观察随访6～12mo,眼压控制≤17mmHg者54眼,眼压≤21mmHg者4眼,眼压为～35mmHg者2眼,未见视网膜脱离、黄斑囊样水肿等并发症。结论:玻璃体抽吸术应用在药物难控制性急性闭角型青光眼能明显降低眼压,为各种青光眼手术的治疗实施提供安全可靠的条件,有助于视功能保护和恢复,提高疗效。

Vitreous aspiration in the treatment of acute angle-closure glaucoma hard-controlled by drug

·AIM:To investigate the effect of vitreous aspiration on the treatment of acute angle-closure glaucoma hard-controlled by drug.·METHODS:Totally 60 cases(60 eyes,male 28,female 32)with acute angle-closure glaucoma enrolled in our hospital,24 hours after drug treatment,intraocular pressure(IOP)were still higher than 21mmHg.IOP was 21-35mmHg in 26 eyes(43%),<35-50mmHg in 18 eyes(30%),more than 50mmHg in 16 eyes(27%).Range of vision was light perception to 0.3.All eyes were treated by pars plana vitreous aspiration treatment(aspiration of vitreous fluid 0.4-1.0mL).·RESULTS:IOP was measured at 3 days after surgery,IOP was≤21mmHg in 14 eyes(23%),<21-35mmHg in 29 eyes(48%),<35-50mmHg in 13 eyes(22%),more than 50 mmHg in 4 eyes(7%);increase of visual acuity was two lines in 28 eyes(47%),increase of visual acuity was1 line in 24 eyes(40%),no increase in visual acuity was 8 eyes(13%);anterior chamber depth deepened in 58 eyes(97%);postoperative hyphema in 16 eyes(27%).After IOP were stable,patients were treated with simple anti-glaucoma surgery in 14 eyes,glaucoma,cataract and intraocular lens(IOL)exchange surgery in 28 eyes,cataract extraction and IOL implantation in 18 eyes.During the postoperative follow-up of 6-12 months,IOP was≤17mmHg in 54 eyes,IOP≤21mmHg in 4 eyes,IOP was <21-35mmHg in 2 eyes.Retinal detachment,cystoid macular edema,etc,were not found.·CONCLUSION:The vitreous aspiration in acute angle-closure glaucoma which is difficult to control by drug has a significant effect of lowering IOP.This method provide safe and reliable conditions for the implementation of a variety of glaucoma surgery and help protect and restore visual function.·