青光眼术后浅前房的观察及处理

目的:探讨青光眼滤过术后浅前房的原因及处理方法。方法:回顾性分析298例462眼青光眼行滤过手术后发生浅前房的原因、类型及处理方法。结果:患者298例462眼中,浅前房99眼,浅前房发生率21.4%。小梁切除术358眼,浅前房77眼,发生率21.5%;小梁切除+MMC(丝裂霉素C)85眼,浅前房20眼,发生率23.5%;青光眼联合白内障超声乳化人工晶状体植入术19眼,浅前房2眼,发生率10.53%。浅前房发生的时间多在术后1～5d,其中滤过过强42眼,占42.4%,脉络膜睫状体脱离29眼,占29.3%;结膜瓣渗漏20眼,占20.2%,恶性青光眼6眼,占6.1%,恶性青光眼并睫状体脉络膜脱离2眼,占2.0%。79眼通过保守治疗恢复前房、20眼经手术治疗恢复前房。结论:浅前房的发生主要与术前高眼压、眼部炎症反应以及术后滤过强、结膜瓣渗透、脉络膜脱离有关,大多数浅前房通过保守治疗可治愈,必要时需手术干预。

Observation and management of shallow anterior chamber after glaucoma surgery

AIM: To analyze the cause and management of shallow anterior chamber after glaucoma surgery.

METHODS: The cause and management of shallow anterior chamber after glaucoma surgery on 298 cases(462 eyes)were analyzed retrospectively.

RESULTS: In 298 cases(462 eyes), 99 eyes(21.4%)had shallow anterior chamber. In 358 eyes treated with trabeculectomy, 77 eyes(21.5%)had shallow anterior chamber. In 85 eyes treated with trabeculectomy+MMC(mitomycin C), 20 eyes(23.5%)had shallow anterior chamber. In 19 eyes treated with trabeculectomy combined with cataract phacoemulsification and intraocular lens implantation, 2 eyes(10.53%)had shallow anterior chamber. Shallow anterior chamber appeared at 1 day to 5 days postoperatively. Forty-two eyes(42.4%)were with excessive filtering, 6 eyes(6.1%)with malignant glaucoma, 29 eyes(29.3%)with choroidal detachment, 2 eyes(2.0%)with malignant glaucoma complicated by choroidal detachment. Of 99 eyes with shallow anterior chamber, anterior chamber of 79 eyes recovered treated by nonsurgical methods, 20 eyes treated by operation.

CONCLUSION: The common cause of shallow anterior chamber after glaucoma surgery was preoperative high intraocular pressure, inflammation, excessive filtering, conjunctival flap flushing and choroidal detachment. Most cases can be managed with nonsurgical methods. Surgical interference should be taken if necessary.