CAJ | 학술논문

目的评价无玻璃体眼并发难治性青光眼的手术治疗方法及效果,分析其治疗策略.方法回顾性病例研究.分析绵阳市中心医院眼科2008年1月至2010年12月因玻璃体切除术后或硅油取出术后并发难治性青光眼患者17例,其中5例采用复合小梁切除手术(A组),8例采用青光眼引流阀植入手术(B组),4例因光感丧失采用 810激光透巩膜睫状体光凝治疗(C组).分析各组随访观察1年的眼压控制情况及并发症情况.采用重复测量的方差分析.结果各组在术后早期眼压均控制良好,术后1年A组术眼眼压平均为(30.44±4.23)mmHg,联合降眼压药物治疗后可将眼压控制在正常范围；B组平均眼压为(20.78±4.54)mmHg;C组平均眼压为(30.79±3.23)mmHg,达到缓解疼痛目的.与治疗前比较,各组眼压明显降低(F=32.20、46.81、27.69,P＜0.01)3组术后均无严重并发症.结论玻璃体切除术后或硅油取出术后并发青光眼因有多次手术史,结膜瘢痕重,属于难治性青光眼,常规复合小梁切除手术因滤过道瘢痕化,远期效果不理想,需联合药物治疗；青光眼引流阀是安全有效的治疗方法,远期降眼压效果理想；对于光感消失患者810激光透巩膜睫状体光凝治疗术后降压药效果确切,是很好的补充手段.
목적 평개무파리체안병발난치성청광안적수술치료방법급효과,분석기치료책략.방법 회고성병례연구.분석면양시중심의원안과2008년1월지2010년12월인파리체절제술후혹규유취출술후병발난치성청광안환자17례,기중5례채용복합소량절제수술(A조),8례채용청광안인류벌식입수술(B조),4례인광감상실채용 810격광투공막첩상체광응치료(C조).분석각조수방관찰1년적안압공제정황급병발증정황.채용중복측량적방차분석.결과 각조재술후조기안압균공제량호,술후1년A조술안안압평균위(30.44±4.23)mmHg,연합강안압약물치료후가장안압공제재정상범위；B조평균안압위(20.78±4.54)mmHg;C조평균안압위(30.79±3.23)mmHg,체도완해동통목적.여치료전비교,각조안압명현강저(F=32.20、46.81、27.69,P＜0.01)3조술후균무엄중병발증.결론 파리체절제술후혹규유취출술후병발청광안인유다차수술사,결막반흔중,속우난치성청광안,상규복합소량절제수술인려과도반흔화,원기효과불이상,수연합약물치료；청광안인류벌시안전유효적치료방법,원기강안압효과이상；대우광감소실환자810격광투공막첩상체광응치료술후강압약효과학절,시흔호적보충수단.
Objective To examine the effectiveness and safety of 3 kinds of surgeries in eyes with refractory glaucoma following vitrectomy.Methods A retrospective study of a non-comparative case series of 17 eyes of 17 patients who had undergone refractory glaucoma surgery following vitrectomy was conducted from Jan.2008 to Dec.2010.Patients were divided into three groups:group A (5 eyes),patients were treated with trabeculectomy,group B (8 eyes),patients were treated with glaucoma valve implantation,and group C (4 eyes),patients were treated with 810 nm laser transcleral cyclophotocoagulation.Data were analyzed using repeated measure ANOVA.Results All three groups had good control of intraocular pressure (IOP) in nonage after surgery.One year after surgery,the mean IOP of group A was 30.44±4.23 mmHg.Medications were needed to lower IOP in this group.The mean IOP of group B was 20.78±4.54 mmHg,which was considered ideal IOP.The mean IOP of group C was 30.79±3.23 mmHg.The differences were significant (F=32.20,46.81,27.69,P＜0.01),compared to preoperative levels.No serious complications occurred after surgery.Conclusion For refractory glaucoma following vitrectomy,trabeculectomy is less effective over the long term and glaucoma valve implantation is a better treatment method.Treatment with 810 nm laser transcleral cyclophotocoagulation can be useful for blind eyes.