恶性青光眼晚期的四联手术治疗

目的：探讨恶性青光眼晚期的手术治疗方法。方法：对恶性青光眼晚期25例（34眼）作房角分离前房形成联合白内障摘出术、玻璃体手术及抗青光眼术四联手术治疗。结果：前房形成1次性成功率为91.2％。超声生物显微镜示术后前房深度较术前明显加深（P＜0.0001）。术后24眼（70.6％）视力提高；眼压明显降低（P＜0.0001）；角膜内皮细胞损 失率为25.8％；六角形内皮细胞出现率增加39.3％。角膜透明度术前后差异无显著性意义（P＝0.1031）。结论：恶性青光眼晚期为多种机制混合存在的难治性、复杂性青光眼，多种联合手术是目前是最有效的治疗方法。

The combined four-surgery for advanced malignent glaucoma

Objective To study the surgical management in advanced malignent glaucoma.Methods Combined goniosynechialysis,cataract extraction,vitrectomy and anti glaucomatous surgery were performed on 34 eyes from 25 patients in advanced malignent glaucoma.Results The successful rate of chamber formation for the first operation was 91.2%.The mean depth of chamber measured with ultrasound biomicroscope(UBM) increased postoperatively( P<0.0001 ).After operation,the visual acuity of 24 eyes (70.6%) improved,the intraocular pressure decreased obviously ( P<0.0001 ),the rate of corneal endothelium loss was 25.8%,the grade of cell hexagonality increased by 39.3%.There were no statistical difference for the corneal transparency before and after operation.Conclusion Advanced malignent glaucoma is the refractory and complicate malignant glaucoma with many pathogenetic mechanisms,for which the multiple surgery is the most effective treatment at present.