外伤性晶状体半脱位继发青光眼的手术治疗

摘要

目的 探讨手术治疗外伤性晶状体半脱位继发青光眼的术式选择及预后.方法 外伤性晶状体半脱位继发青光眼患者35例(35只眼),术前均采用房角镜和(或)超声生物显微镜(ultrasound biomicroscopy,UBM)检查,根据其前房角粘连和晶状体脱位范围选择适当的手术方式,包括YAG激光周边虹膜切除术、白内障囊外摘除、囊袋张力环植入、人工晶状体植入、复合式小梁切除以及前部玻璃体切割的组合使用,平均随访12个月,对其治疗方法和效果进行回顾性分析.结果 所有患者术后最佳矫正视力均较术前有不同程度提高.28例房角有粘连的患者中,有25例的术后眼压控制在正常范围,另外3例于术后3个月出现眼压增高,加用降眼压药物后控制在正常范围.7例房角开放的患者仅去除脱位晶状体,未实施小梁切除手术,眼压降低效果理想.无严重并发症发生.结论 对于外伤性晶状体半脱位继发青光眼,根据患者晶状体、房角、眼压及视力等具体情况选择合适的手术方式可以有效控制眼压并提高术后视力,减少术后并发症.%OBJECTIVE To discuss the surgical options and prognosis of traumatic glaucoma associated with subluxation of lens. METHODS This retrospective study comprised 35 eyes of 35 patients with high intraocular pressure (IOP)and traumatic lens subluxation. All patients underwent UBM examination preoperatively. Depending on the extension of zonulolysis and goniosynechia, proper surgical intervention, including YAC laser iridotomy, ex-tracapsular cataract extraction, capsular tension ring implantation, intraocular lens implantation or combined tra-beculectomy and anterior vitrectomy was implemented. Mean follow-up time was 12 months. The treatments and effects were analyzed retrospectively. RESULTS Best corrected visual acuity of all patients was improved in varying degrees. Of the 28 cases with angle synechia, postoperative IOP of 25 cases were controlled. The IOP of the other 3 patients began to increase 3 months postoperatively, and were controlled well with topical medication. Len extractions without trabeculectomy were implemented for 7 cases with open angles, and the IOP returned to normal. No serious complications occurred. CONCLUSIONS Appropriately selected surgical approach depending on the conditions of lens,anterior chamber angle, intraocular pressure and visual acuity could effectively control the IOP, improve visual acuity and reduce postoperative complications.