国际眼科杂志
國際眼科雜誌
국제안과잡지
International Eye Science
2015年
9期
1645-1647
,共3页
孟王乐%韩晓冬%李燕龙%杨敏
孟王樂%韓曉鼕%李燕龍%楊敏
맹왕악%한효동%리연룡%양민
恶性青光眼%玻璃体切除术
噁性青光眼%玻璃體切除術
악성청광안%파리체절제술
malignant glaucoma%vitrectomy
目的：观察应用25 G微创玻璃体手术治疗恶性青光眼的临床效果。<br> 方法：回顾性分析2012-09/2013-10在我院就诊的恶性青光眼确诊患者11例13眼,所有患者均有明确的闭角型青光眼病史及小梁切除联合周边虹膜切除手术史。入院时平均最佳矫正视力( LogMAR视力)为0.70依0.13；平均眼压41.3依12.7 mmHg；UBM检查提示角膜及睫状体水肿,晶状体(或人工晶状体)及虹膜位置显著前移,平均前房深度0.69依0.17 mm。所有患者均接受25 G经睫状体扁平部前部玻璃体切除联合后囊膜切开手术治疗,其中,有晶状体眼7眼,术中联合白内障超声乳化并植入人工晶状体。<br> 结果：术后随访6~18(平均11.7依5.4)mo。末次随访平均最佳矫正视力提高至0.29依0.08；平均眼压为18.6依3.9 mmHg；术后1 mo复查UBM 提示睫状体水肿消退,人工晶状体及虹膜平面平坦,平均前房深度2.48依0.31 mm。术后早期并发症包括角膜水肿、后弹力层皱褶、前房炎症反应、纤维素性渗出、虹膜局限性后粘连及低眼压(眼压≤5mmHg)。1眼术后眼压升高至26.4mmHg,需长期局部应用一种降眼压药物以控制眼压≤21 mmHg。无角膜内皮细胞失代偿、人工晶状体夹持、眼内出血、感染、眼压失控等严重并发症发生。<br> 结论：25 G微创玻璃体手术可有效控制恶性青光眼患者的眼压,并减少传统玻璃体手术的相关并发症,联合白内障超声乳化手术可提高手术成功率及患者视功能。
目的：觀察應用25 G微創玻璃體手術治療噁性青光眼的臨床效果。<br> 方法：迴顧性分析2012-09/2013-10在我院就診的噁性青光眼確診患者11例13眼,所有患者均有明確的閉角型青光眼病史及小樑切除聯閤週邊虹膜切除手術史。入院時平均最佳矯正視力( LogMAR視力)為0.70依0.13；平均眼壓41.3依12.7 mmHg；UBM檢查提示角膜及睫狀體水腫,晶狀體(或人工晶狀體)及虹膜位置顯著前移,平均前房深度0.69依0.17 mm。所有患者均接受25 G經睫狀體扁平部前部玻璃體切除聯閤後囊膜切開手術治療,其中,有晶狀體眼7眼,術中聯閤白內障超聲乳化併植入人工晶狀體。<br> 結果：術後隨訪6~18(平均11.7依5.4)mo。末次隨訪平均最佳矯正視力提高至0.29依0.08；平均眼壓為18.6依3.9 mmHg；術後1 mo複查UBM 提示睫狀體水腫消退,人工晶狀體及虹膜平麵平坦,平均前房深度2.48依0.31 mm。術後早期併髮癥包括角膜水腫、後彈力層皺褶、前房炎癥反應、纖維素性滲齣、虹膜跼限性後粘連及低眼壓(眼壓≤5mmHg)。1眼術後眼壓升高至26.4mmHg,需長期跼部應用一種降眼壓藥物以控製眼壓≤21 mmHg。無角膜內皮細胞失代償、人工晶狀體夾持、眼內齣血、感染、眼壓失控等嚴重併髮癥髮生。<br> 結論：25 G微創玻璃體手術可有效控製噁性青光眼患者的眼壓,併減少傳統玻璃體手術的相關併髮癥,聯閤白內障超聲乳化手術可提高手術成功率及患者視功能。
목적：관찰응용25 G미창파리체수술치료악성청광안적림상효과。<br> 방법：회고성분석2012-09/2013-10재아원취진적악성청광안학진환자11례13안,소유환자균유명학적폐각형청광안병사급소량절제연합주변홍막절제수술사。입원시평균최가교정시력( LogMAR시력)위0.70의0.13；평균안압41.3의12.7 mmHg；UBM검사제시각막급첩상체수종,정상체(혹인공정상체)급홍막위치현저전이,평균전방심도0.69의0.17 mm。소유환자균접수25 G경첩상체편평부전부파리체절제연합후낭막절개수술치료,기중,유정상체안7안,술중연합백내장초성유화병식입인공정상체。<br> 결과：술후수방6~18(평균11.7의5.4)mo。말차수방평균최가교정시력제고지0.29의0.08；평균안압위18.6의3.9 mmHg；술후1 mo복사UBM 제시첩상체수종소퇴,인공정상체급홍막평면평탄,평균전방심도2.48의0.31 mm。술후조기병발증포괄각막수종、후탄력층추습、전방염증반응、섬유소성삼출、홍막국한성후점련급저안압(안압≤5mmHg)。1안술후안압승고지26.4mmHg,수장기국부응용일충강안압약물이공제안압≤21 mmHg。무각막내피세포실대상、인공정상체협지、안내출혈、감염、안압실공등엄중병발증발생。<br> 결론：25 G미창파리체수술가유효공제악성청광안환자적안압,병감소전통파리체수술적상관병발증,연합백내장초성유화수술가제고수술성공솔급환자시공능。
AIM:To evaluate the efficacy of 25G vitrectomy surgery for malignant glaucoma. <br> METHODS:Thirteen eyes of 11 patients with malignant glaucoma who had a history of primary angle-closure glaucoma were analyzed retrospectively from September 2012 to October 2013 in our hospital. All patients had undergone a prior surgery of trebeculectomy combined with iridectomy. The pre-operative mean best corrected visual acuity ( BCVA) in LogMAR was 0. 70±0. 13 and the mean intraocular pressure ( IOP) was 41. 3±12. 7mmHg. Corneal edema, ciliary body edema and very shallow anterior chamber with a mean value of 0. 69±0. 17mm were showed by ultrasound biomicroscopy ( UBM ) . Anterior vitrectomy and posterior capsulotomy were performed with 25G vitrectomy system in all eyes. Seven phakic eyes underwent phacoimulsification combined IOL implantation surgery during vitrectomy. <br> RESULTS: The patients were followed up for 6 ~18mo with an average of 11. 7±5. 4mo. BCVA at the last follow-up improved to 0. 29±0. 08 and the mean IOP was 18. 6±3.9mmHg. UBM results showed that ciliary body edema was eliminated, the iris was flattened and the anterior chamber was deepened with a mean depth of 2. 48 ±0.31mm at 1mo after surgery. Postoperative complications included corneal edma, Descemet membrane folds, anterior chamber inflammation, fibrotic exudation, local iris posterior synechia and hypotony (IOP≤5mmHg). One eye had high IOP of 26. 4mmHg and required long-term topical antiglaucoma medication to control the IOP≤21mmHg. No complications such as corneal endothelium decompensation, IOL capture, intraocular hemorrhage, infection and uncontrolled IOP were observed. <br> CONCLUSION: 25G vitrectomy is safe and effective for treating malignant glaucoma, controls IOP and reduces complications associated with traditional vitrectomy. Combined vitrectomy with phacoemulsification may improve the success rate and visual function.
