伴有尿毒症的青光眼患者的治疗

目的探讨伴有尿毒症的青光眼患者的治疗。方法回顾性分析1997年1月至2007年9月在中山大学附属第一医院连续住院的伴有尿毒症的青光眼患者20例（23眼），包括病史、视力、眼压、眼部表现、诊断、治疗方法及治疗效果。结果14例15眼（14／20，70．0％）新生血管性青光眼（neo-vascular glaucoma，NVG）中，14眼无光感，1眼光感。14例患者中，6例因全身情况差不能耐受手术而单用药物降眼压（其中5例眼痛症状可暂时缓解，1例不能缓解）；3例行睫状体冷冻或光凝后眼痛症状不能缓解最终行眼球摘除术；2例行睫状体冷冻加用抗青光眼药物后控制症状；2例角巩膜葡萄肿和1例眼球自发破裂患者行眼球摘除术；1例2眼房水引流物植入后症状消失但眼压控制不理想。6例眼球摘除术后其中3例（3／6，50．0％）球结膜显著水肿。4例5眼（4／20，20．O％）急性闭角型青光眼和2例3眼（2／20，10．0％）皮质类固醇性青光眼行抗青光眼手术或应用降眼压药物后眼压控制正常。结论NVG是伴有尿毒症的青光眼患者最常见的类型，治疗棘手，预后差。

The treatment of glaucoma in uremia patients

Objective To investigate the treatment of ghucoma in uremia patients.Methods 20 patients(23 eyes)hospitalized continuously in the first affiliated hospital of Sun Yat-sen University from January in 1997 to September in 2007 were investigated retrospectively,based on their medical history,visual activity,intraocular pressure,ocular manifestation,diagnosis,treatment and the therapeutic effect.Results14 patients(15 eyes) (14/20,70.0%)were neovascular glaucoma(NVG).14 eyes showed visual loss and 1 eye was light perception.6 patients who cannot be tolerant to the surgery for their poor condition were given with pressure-lowering agents which can control the ocular symptom of 5 patients temporarily and failed to I patient.3 patients failed with medication and coagulation by laser or cryoab|ation of ciliary body and enucleation was performed finally.Cyelocryotherapy and medication can control the symptom of 2 patients.2 patients of corneal and seleral staphyloma and 1 patient of spontaneous eyeball rupture were performed to enucleation.2 eyes of 1 patient were implanted with aqueous drainage devices and cannot control intraoeular pressure well.The bulhar conjunctiva of 3 patients was edema dramatically in all 6 patients of enueleation.The 10P of 4 patients(5 eyes)with acute angleclose glaucoma and 2 patients(3 eyes)with corticosteroid glaucoma was controlled well by glaucoma surgery or medication.ConclusionNVG is the most common type of uremia associated with glaucoma and is difficult to manage.