前房穿刺术联合改良复合式小梁切除术治疗AACG高眼压持续状态

目的：探讨急性闭角型青光眼( acute angle-closure glaucola,AACG)急性发作,持续性高眼压药物不能控制下,行前房穿刺联合改良复合式小梁切除手术,对高眼压持续状态的治疗效果。
　　方法：选取2011-06/2015-06间我科收入住院治疗的急性闭角型青光眼急性发作期高眼压持续状态患者共37例37眼,术前视力：光感者2眼,手动者3眼,指数者6眼,0.01者8眼,0.05者6眼,0.1者5眼,0.2者3眼,0.25者2眼,0.3者2眼；眼压：40~50 llHg 者14眼,51~60 llHg者11眼,61~70 llHg者7眼,71~80 llHg者5眼；前房：Ⅱ级浅前房者29例,Ⅲ级浅前房者8例。经过24~72 h综合降眼压药物治疗后眼压未能控制,即行患眼前房穿刺放液术,眼压降至21 llHg以下1~2 d后,即行小梁切除+房角分离术+MMC,术后全身和局部抗炎、抗感染、对症等治疗。
　　结果：术后视力情况：0.1~0.2者3眼,0.25者4眼,0.3者6眼,0.4者8眼,0.5者7眼,0.6者6眼,0.8以上者3眼。眼压：术后不用降眼压药物眼压在10~21 llHg 者26眼,术后用1~2种降眼压药物后眼压在23~27 llHg者8眼,术后用2~3种降眼压药物后眼压仍居高不降,在30~38 llHg之间而再次行手术治疗者3眼。前房分级：l级28眼,Ⅱ级6眼,Ⅲ级3眼；滤泡分型：l型功能性滤泡21眼,Ⅱ型功能性滤泡13眼,Ⅲ型为非功能性滤泡2眼、Ⅳ型为非功能性滤泡1眼。全部患者术中未出现暴发性脉络膜出血、玻璃体脱出及术后恶性青光眼等并发症发生。其中有3例患者再次行白内障超声乳化吸出+IOL植入+小梁切除三联术。
　　结论：急性闭角型青光眼急性发作期患者,在高眼压持续状态下,施行前房穿刺放液联合改良复合式小梁切除手术,是有效、安全可行的,大大减少了术中、术后并发症的发生,显著提高了手术质量和效率,进一步提高了手术的成功率。

Applications of anterior chamber paracentesis with improved compound trabeculectomy for persistent state of high IOP in patients with acute angle-closure glaucoma

AlM: To investigate the effect of anterior chamber paracentesis combined with improved compound trabeculectomy for persistent state of high intraocular press ( lOP ) in patients with acute angle - closure glaucoma ( AACG) failed in drug control.
METHODS:Thirty-seven AACG patients (37 eyes) with persistent state of high lOP admitted in our hospital from June 2011 to June 2015 were selected. Vision:there was light perception in 2 eyes, hand movement in 3 eyes, finger count in 6 eyes, 0. 01 in 8 eyes, 0. 05 in 6 eyes, 0. 1 in 5 eyes, 0. 2 in 3 eyes, 0. 25 in 2 eyes, 0. 3 in 2 eyes;lOP:40-50 mmHg in 14 eyes, 51-60 mmHg in 11 eyes, 61-70 mmHg in 7 eyes, 71 - 80mmHg in 5 eyes; Anterior chamber: 29 patients got Ⅱ grade shallow anterior chamber and 8 patients got Ⅲ grade. After 24-72h of comprehensive ocular hypotensive medications failed to control lOP, paracentesis was applied. At 1-2d after lOP dropped to 21mmHg or less, patients received trabeculectomy combined with goniosynechialysis and mitomycin ( MMC ) . Postoperative systemic and topical anti - inflammatory, anti - infection, symptomatic treatments were applied.
RESULTS:Postoperative vision was 0. 1-0. 2 in 3 eyes, 0. 25 in 4 eyes, 0. 3 in 6 eyes, 0. 4 in 8 eyes, 0. 5 in 7 eyes, 0. 6 in 6 eyes and 0. 8 or more in 3 eyes. Postoperative lOP was controlled within 10-21mmHg without medication in 26 eyes, within 23-27mmHg with 1-2 kinds of anti-glaucoma medications in 8 eyes, 3 eyes failed in drug decompression with 2-3 medications and remained high lOP of 30-38mmHg at last underwent surgery again. The chamber grading was grade l in 28 eyes, grade Ⅱ in 6 eyes,Ⅲ grade in 3 eyes. Filtering bleb type was type l of functional filtering bleb in 21 eyes, type Ⅱ functional filtering bleb in 13 eyes, typeⅢof non-functional filtering bleb in 2 eyes, typeⅣof non-functional filtering bleb in 1 eyes. No case occurred complications such as fulminant choroidal hemorrhage, vitreous loss or postoperative malignant glaucoma. There were 3 eyes underwent phacoemulsification cataract combined with lOL implantation and trabeculectomy triple surgery again.
CONCLUSlON:ln statement of persistent high lOP in acute angle - closure glaucoma patients with acute exacerbation, anterior chamber paracentesis combined with improved compound trabeculectomy surgery is effective, safe and feasible, greatly reducing postoperative complications, significantly improving the quality and efficiency of operation, and further improving the success rate of surgery.