恶性青光眼的临床特征和危险因素分析

目的　探讨原发性闭角型青光眼（ｐｒｉｍａｒｙａｎｇｌｅｃｌｏｓｕｒｅｇｌａｕｃｏｍａ，ＰＡＣＧ）患者行手术治疗后发生恶性青光眼的临床特征以及相关的危险因素。方法　回顾性分析我院收治的２３８６例（２８９７眼）ＰＡＣＧ行手术治疗患者的临床资料，按术后是否发生恶性青光眼分为恶性青光眼组与非恶性青光眼组，探讨恶性青光眼组患者的临床特征，并采用Ｌｏｇｉｓｔｉｃ回归方法对ＰＡＣＧ患者术后发生恶性青光眼危险因素进行分析。结果　ＰＡＣＧ患者手术后恶性青光眼的发生率为２．９３％。恶性青光眼组患者的女性比例、行小梁切除术比例、术前眼压、晶状体厚度、房角完全闭合比例均显著高于非恶性青光眼组（均为Ｐ＜０．０５），前房深度、眼轴长度均显著低于非恶性青光眼组（均为Ｐ＜０．０５）。两组间的年龄、病程、血压、相对晶状体位置等临床参数比较，差异均无统计学意义（均为Ｐ＞０．０５）。女性、年龄４５～６０岁、小梁切除术、术前眼压＞３０ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ）、前房深度＜１．８ｍｍ、晶状体厚度＞４．５ｍｍ、眼轴长度＜２２ｍｍ、房角完全闭合是ＰＡＣＧ患者术后发生恶性青光眼的危险因素，其中，短眼轴、术前持续高眼压、房角完全闭合３个因素是ＰＡＣＧ患者术后发生恶性青光眼的独立危险因素。结论　性别、年龄、眼压以及患者自身的眼球解剖结构是ＰＡＣＧ术后发生恶性青光眼的易感因素，需引起临床研究者的重视。

Analysis of clinical characteristics and risk factors of malignant glaucoma

Objective To investigate the clinical characteristics and risk factors of primary angle closure glaucoma ( PACG) complicated with postoperative malignant glaucoma. Methods Clinical records of 2386 PACG patients post-operation in our hospital were retrospectively analyzed. The recruited patients were divided into malignant glaucoma ( MG) and non-malignant glaucoma ( NMG) group. Setting NMG as the control group , the clinical characteristics of MG patients were studied . and Logistic analysis was applied to explore the risk factors of glaucoma. Results The incidence of malignant glaucoma after filtering surgery was 2. 93% in PACG patients. The proportion of female ,proportion of fully closed anterior chamber angle ,lens thickness and anterior chamber intraocular pressure in MG group were sigruficantly higher than those in NMG group ( all P < 0. 05 ) . while anterior chamber depth and axial length were sigruficantly lower ( all P < 0. 05 ) . There was no significant difference in clinical parameters such as age , duration of disease.blood pressure . and LOWE coefficient between the two groups ( all P > 0. 05 ) . Female , aged 45 t0 60 years , performed with trabeculectomy , preoperative intraocular pressure > 30 mmHg ( I kPa = 7. 5 mmHg) , anterior chamber depth < 1. 8 mm,lens thickness > 4. 5 mm . axis length < 22 mm, fully closed anterior chamber angle were the risk factors of postoperative malignant glaucoma in PACG patients. Among these factors , short axial length , high intraocular pressure , and structure of anterior chamber were the independent risk factors of malignant glaucoma. Conclusion Gender, age ,intraocular pressure and anatomy structure are the susceptible factors of postoperative malignant glaucoma in PACG patients , which should arouse the attention of clinical researchers.