青光眼滤过性手术后晚期脉络膜脱离的研究

目的 探讨青光眼滤过性手术后晚期脉胳膜脱离的发病机制和治疗。方法对6例(6眼)青光眼滤过性手术后晚期发生脉胳膜脱离(脉脱)者进行回顾性分析。闭角型青光眼4眼，开角型青光眼1眼和炎症性青光眼1眼，均有不成功的滤过性手术史和多种药物治疗史。结果术后6～35月(平均27月)经B超证实脉脱。2眼停用房水抑制剂加用睫状肌麻痹剂和皮质激素后，脉脱复位。其中1眼以后再用噻吗心安时脉脱复发。4眼炎症反应严重者，药物治疗无效分别作脉胳膜放液、前房再造和白内障摘出术。治疗后6眼中3眼恢复了有用视力，1眼角膜失代偿。4眼需继续使用降眼压药物。结论青光眼滤过手术后晚期脉胳膜脱离，与房水抑制剂及眼内炎症有关。本病诊断较易，但控制眼压，保持视力有一定困难。

Choroidal detachment at the late stage fllowing glaucoma filtering surgery

Objective To study pathogenesis and therapy of choroidal detachment at the late period following filtering surgery.Methods Six patients with choroidal detachment at late stage fitering surgery,who had a history of angle closure glaucoma(4 eyes),open angle glaucoma(1 eye) inflammatory glaucoma (1 eye) with failed operation and multiple medical therapy (including timolol and/or acetazolamide),were retrospectively analyzed.Results 6-35 months after operation,six cases appeared choroidal detachment proved by B-scan ultrasonography.Two eyes were cured with disconinued pharmcology aqueous suppressant therapy and added cycloplegia mydriatics and steroid.Their anterior chamber reformed and intraocular pressure got reised,but one of them developed recurrent choroidal detachment following timolol administrated again.Other 4 eyes with severe inflammatory faction were treated with choroidal tap,reforming anterior chamber and cataract extraction after with failed medicine control.Postoperativly,3 eyes got useful vision.Corneal decompensation occurred subsequently in 1 case.Medicine controlling for intraocular pressure was still required in 4 eyes.Conclusion The chroroidal detachmeht at late stage in previous filtering eyes is related to aqueous suppressant therapy and intraocular inflammatory reaction.Identification of these symptoms are easy but to control intraocular pressure and preserve vision sometimes difficult.