脉络膜上腔引流术治疗难治性青光眼的疗效分析

目的评价脉络膜上腔引流术治疗难治性青光眼的有效性和安全性。方法对22例23眼眼压失控的难治性青光眼患者进行前瞻性连续病例研究。每眼均接受小梁切除手术和（或）睫状体破坏性手术治疗和（或）给予最大量药物治疗，基础眼压仍在（43±7）mnlHg（1mmHg=0．133kPa）。手术大体成功的判断标准为：术后眼内压（tOP）≤20mmHg，与用药和不用药时的基线IOP相比：IOP下降30％；无视盘凹陷进行性加深；无视野进行性受损。当不需要药物治疗时认为手术完全成功，未达到以上标准需要手术矫正或进一步行前房穿刺的病例视为治疗失败。患者术后平均随访时间为（18±6）个月。结果术前平均IOP为（43±7）mmHg，术后平均10P（13±5）mmHg，两者之间比较差异有统计学意义（t=20．12，P〈0．01）。术后随访16～20个月，19眼（82．6％）获得大体成功，16眼（69．5％）为完全成功，4眼（17．3％）失败。无一眼术后出现严重的浅前房、低眼压或脉络膜上腔出血。无因硅管植入而发生异物排斥反应、局部或全身炎症或感染。2眼（8．6％）因前房出血而行前房冲洗术，1眼（3．4％）因硅管脱位与角膜内皮接触而将硅管取出，3眼（13．0％）因硅管后部结缔组织形成阻塞硅管而导致引流失败者。结论这一新方法的优点是巩膜内引流通路减少了结膜糜烂和感染的危险，将硅管置于睫状体之上避免了手术性睫状体脱离，将硅管连接至脉络膜上腔可充分利用脉络膜的再吸收能力，除确保充分引流外，也能提供自然的对抗压力，避免严重的术后低眼压。该方法可能成为较有效的手术技术，为难治性青光眼提供了一种新的治疗选择。

Suprachoroidal drainage for the surgical treatment of refractory glaucoma

surgical treatment trollable refractory Objective To evaluate the efficacy and safety of suprachoroidal drainage for the of refractory glaucoma. Methods Twenty - three eyes of 22 patients with uncon- glaucoma were included in this prospective consecutive case control study. Each eye had undergone previous trabeculectomy or cycloeryotherapy or maximum therapy for glaucoma. The baseline IOP was （43 ＋7） mm Hg （1 mmHg=0. 133 kPa）. Surgical outcome was defined as an overall success by the following criteria： postoperative intraocular pressure （IOP） ≤20 mm Hg, and IOP reduction 30% compared with baseline values with or without medication; no visual field deterioration; no optic - disc progression. When medications were not required, success was defined as complete. Cases that did not fulfill the aforementioned criteria and cases in which a surgical revision or further goniopuncture was performed were defined as a failure. Follow - up was （ 18 ＋6） months after surgery. Results There were significant difference between the mean preoperative in- traocular pressure and the mean postoperative intraocular pressure（ t = 20.12, P 〈 0.01 ） ,the mean preoperative intraocular pressure was （43 ＋ 7 ）mm Hg; the mean postoperative intraocular pressure was （ 13 ＋5 ）mm Hg. Sixteen to twenty months after operation, 19 eyes （82.6%） were considered an overall success. In 16 eyes （69.5%）, success was complete. Four eyes （17.3%） were considered failures. None of the eyes showed severe postoperative hypotony or suprachoroidal bleeding. No localized or general inflammation or infection was seen in connection with the silicon tube. Two eyes（8.6% ）needed anterior chamber lavage because of bleeding. In one eye （3.4%）, the tube had to be removed because of corneal endothelial contact. Shunt failure of the tube was caused in three eyes （ 13.0% ） by connective tissue formation at the posterior lumen of the tube. Conclusions This novel surgical approach and the placement of the silicone tube described here have several advantages. Its intrascleral course minimizes the risk of conjunctival erosion and associated infections. No cyclodialysis is performed. Connection to the suprachoroidal space exploits the resorptive capability of the choroid. It guarantees drainage but also provides a natural counterpressure, avoiding severe postoperative hypotony. The suprachoroidal shunt presented here achieves good follow - up results in terms of IOP control. No serious complications have been observed. This new method promises to be an effective surgical technique and presents a new therapeutic option in intractable glaucoma.