个性化方案治疗恶性青光眼的疗效分析

目的:探讨恶性青光眼的个性化治疗方法。方法:回顾分析2016-01/2018-10在我院眼科中心接受治疗的恶性青光眼患者19例19眼的临床资料,观察治疗前后的最佳矫正视力(LogMAR)、眼压、前房深度及并发症。结果:选取的患者中7眼经药物治疗后眼压下降、前房恢复,3眼行YAG激光虹膜周边切除+后囊膜切开+玻璃体前界膜切开,5眼行白内障超乳化+人工晶状体植入+前部玻璃体切除+后囊膜切开术,2眼行前部玻璃体切除+后囊膜切开,1眼行玻璃切除术,1眼在术中发生恶性青光眼患者予以玻璃腔水囊穿刺抽液后完成小梁切除+白内障超声乳化吸出术。术后患眼均眼压下降,前房恢复,部分患者视力提高。眼压由治疗前31.25±5.19mmHg降至治疗后14.43±3.46mmHg (P<0.05),前房轴深由治疗前0.69±0.57mm恢复至治疗后2.64±0.47mm(P<0.05),术前最佳矫正视力为0.71±0.25,术后为0.34±0.19(P<0.05)。除1眼出现低眼压、脉络膜脱离外,其余患者未见明显严重并发症。结论:恶性青光眼发生后需充分评估患者具体情况,根据患者病情采取个性化的治疗方法。

Analysis of efficacy in individual-based treatment for malignant glaucoma

AIM: To study individualized treatment of malignant glaucoma.

METHODS: Totally 19 malignant glaucoma patients(19 eyes)admitted in Leshan Ophthalmological Center from January 2016 to October 2018 were retrospectively analyzed. Main outcomes of best corrected visual acuitv, intraocular pressure(IOP), anterior chamber depth and complications were closely observed.

RESULTS: IOP were recovered by drug treatments in 7 eyes to anterior chamber depth. 3 eyes were treated by peripheral iridectomy combined with posterior capsule of lens and anterior vitreous membrane excision with YAG laser. 5 eyes were treated by cataract phacoemulsification with foldable intraocular lens implantation combined with posterior capsule excision and anterior vitrectomy. 1 eye was treated by vitrectomy.1 eye developed to malignant glaucoma during operation was treated by trabeculectomy combined with cataract phacoemulsification after vitreous water-bag was punctured. The post-treatment IOP(14.43±3.46mmHg)significantly declined compared with pre-treatment IOP(31.25±5.19mmHg), the post-treatment anterior chamber depth(2.64±0.47mm)significantly deepened compared with that of pre-treatment(0.69±0.57mm). The best corrected visual acuity in LogMAR before treatment was 0.71±0.25, after the treatment of 0.34±0.19(P<0.05). There were no serious complications except 1 case with low intraocular pressure and choroidal detachment.

CONCLUSION: It is necessary to fully evaluate the specific conditions of patients after the occurrence of malignant glaucoma and adopt individualized treatments according to patient''s condition.