优化恶性青光眼治疗方法

目的：：探讨恶性青光眼治疗方法的选择。方法：设计回顾性病例分析,回顾分析2012-05/2013-05在我院眼科中心接受治疗的21例恶性青光眼患者的临床资料,21例21眼恶性青光眼患者,发生于小梁切除术后16眼(76%),青光眼引流钉术后3眼(14%),青光眼引流阀术后2眼(10%)。主要指标矫正视力、眼压、前房深度及并发症。结果：患者13眼经药物治疗后眼压下降前房恢复,4眼行玻璃体水囊抽吸+前房成形术,2眼行白内障超声乳化+人工晶状体植入术,2眼(白内障术后)行前部玻璃体切除+后囊膜切开,术后均眼压下降恢复前房。眼压由治疗前29.81±4.98 mmHg 降至治疗后12.71±3.77 mmHg ( P=0.00),前房轴深由治疗前0.41±0.34 mm 升至治疗后2.13±0.54mm(P=0.00),术前矫正视力0.19±0.17,术后矫正视力0.20±0.16(P=0.36)。除1眼行玻璃体水囊抽吸后少量玻璃体出血,给予药物治疗后玻璃体出血吸收,余所有患者在治疗过程中及治疗后均未见明显眼部或全身不良反应。结论：及早发现恶性青光眼,采用循序渐进的方法治疗恶性青光眼效果明显,能够降低眼压,恢复前房。

Optimal treatment for malignant glaucoma

AIM:To investigate the choice of different treatments for malignant glaucoma.

METHODS: In this retrospective case series, 21 malignant glaucoma patients(21 eyes)admitted in Wuhan General Hospital of Guangzhou Military Command from May 2012 to May 2013 were analyzed. Sixteen eyes(76%)developed malignant glaucoma after filtration surgery, 3 eyes(14%)after EX-PRESS glaucoma filtration device, 2 eyes(10%)after glaucoma filtration Ahmed valve implantation. Main Outcome of corrected visual acuity, intraocular pressure(IOP), anterior chamber depth and complications were detected.

RESULTS: IOP recovered by drug control in 13 eyes, anterior chamber depth. Four eyes were treated by vitreous water-bag aspiration combined with anterior chambers reconstructing. Two eyes were treated by cataract extraction and intraocular lens implantation. Two eyes were treated by posterior capsule excision combined with anterior vitrectomy. IOP before and after treatment was 29.81±4.98, 12.71±3.77mmHg, respectively(P=0.00). Anterior chamber depth before and after treatment was 0.41±0.34, 2.13±0.54mm, respectively(P=0.00). Corrected visual acuity before treatment was 0.19±0.17, after treatment was 0.20±0.16(P=0.36). Except for vitreous hemorrhage in 1 eye, there were no ocular or systemic adverse events observed in all patients.

CONCLUSION: It is good to diagnose malignant glaucoma in early period, and treated it step by step. For this can reduce IOP and restore anterior chamber.