青光眼白内障联合IOL植入术后浅前房的手术治疗

目的:探讨青光眼白内障联合人工晶状体植入术(三联手术)后浅前房的原因及手术治疗。方法:青光眼白内障联合人工晶状体植入术后浅前房患者17例17眼,术后出现浅前房的时间20d～4mo,平均1.6±0.5mo;术前眼压28.2～43.3(平均33.2±5.7)mmHg(1mmHg=0.133kPa);视力:<0.05者7眼,0.05～者5眼,0.1～0.3者3眼,>0.3者2眼。有明显瞳孔后粘连者16眼。3眼行单纯无灌注前段玻璃体切割术,14眼行无灌注前段玻璃体切割+6∶00位虹膜根部切除术,其中2眼行二次以上手术,随访12mo。结果:术后一次性前房形成率88.2%(15/17),需行二次手术11.8%(2/17);视力:<0.05者3眼,0.05～者2眼,0.1～0.3者7眼,>0.3者5眼;术后平均眼压14.7±3.4mmHg,所有患者均无浅前房、滤过泡渗漏、脉络膜脱离及脉络膜上腔出血等严重并发症发生。结论:瞳孔后粘连是三联手术后浅前房的主要原因,无灌注前段玻璃体切割+虹膜根部切除术是治疗三联手术后浅前房的有效、可靠方法。

Surgery treatment of shallow anterior chamber after three association techniques

AIM: To observe the reason and surgery treatment of shallow anterior chamber after three association techniques(compound trabeculectomy+phacoemulsification+intraocular lens implantation).

METHODS:Totally 17 eyes of 17 cases with shallow anterior chamber were treated with compound trabeculectomy+ phacoemulsification +intraocular lens implantation, the shallow anterior chamber appeared after 20 days-4 months, an average of 1.6±0.5 months; Before operation, intraocular pressure was 28.2-43.3mmHg, average 33.2±5.7mmHg(1mmHg=0.133 kPa); best-corrected visual acuity in 7 cases was <0.05, in 5 cases was 0.05-0.1, in 3 cases was 0.1-0.3, in 2 cases was >0.3. 16 eyes had the obvious pupillary posterior synechiae. 3 eyes underwent the purely nonirrigation anterior vitrectomy, 14 eyes underwent the nonirrigation anterior vitrectomy+ peripheral iridoctomy at 6 position, in which 2 eyes had experienced two or more operations. All cases were observed for 12 months.

RESULTS: The successful rate of chamber formation for the first operation was 88.2%(15/17). The rate of experienced two or more operations was 11.8%(2/17); best-corrected visual acuity in 3 cases was <0.05, in 2 cases was 0.05-0.1, in 7 cases was 0.1-0.3, in 5 cases was >0.3. After operation, intraocular pressure was 14.7±3.4 mmHg, all patients had no shallow anterior chamber, bleb leakage, choroidal detachment, malignant glaucoma, choroidal hyphema and so on.

CONCLUSION:Pupillary posterior synechiae is the main reason of shallow anterior chamber after three association techniques. The nonirrigation anterior vitrectomy+the peripheral iridoctomy is an effective, reliable method to treat shallow anterior chamber after three association techniques.